310077_INSPECTIONS_20171231

2 V
NORTH CAROLINA
Department of Environmental Qual

It
®IVISIOn O WaterReSonrCCS s� ;" y x cat 1"
Facility Number f - 7 7 0-
Division of Soll,and Water Conservatlon��� - may* ,� , .F -
O
Other Agency L4•
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
c�
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: Region -
Farm Name: Owner Email:
Owner Name: _ a ,, ; To - r��,/ d G Phone:
Mailing Address:
Physical Address:
Facility Contact: (-5PrY/_MIDdy� Title: L'—d-
Onsite Representative: Y��t, Integrator:
Phone:
Certified Operator: u Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current:.m
y. DesignDesign 1Curr nU= �.
Swine
Capacity Pop.
�..
Wet Poultry Capacity .Pop Cattle `"`°Capac�ty1'op 4
w , ,
Wean to Finish
Layer Dai Cow
Wean to Feeder
Non La er Dai Calf
Feeder to Finish
Dairy Heifer ` 9
Farrow to Wean
�DesignCurrent D Cow 3
Farrow to Feeder
°u.. a�a Non -Dairy
-Dry Pouf,, -,'Capacity,,--, Po
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Pullets U Beef Brood Cow
Turkeys x
Other
u
TurkeyPoints
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
ELNo
❑ NA
❑ NE
❑ Yes
jo No
❑ NA
❑ NE
Page l of 3
21412015 Continued

Facility Number: / - 7 Date of inspection;
Waste Collection & Treatment
*� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes S No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E� No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E[No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes &No
D NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2LNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
p,
13. Soil Type(s):D/
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [LNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZLNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
D. Yes
[K No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

1
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
r
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JZLNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ef No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
5Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[K No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MI-- No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
MNo
❑ NA
❑ NE
702
3I "5V WIfIf
Reviewer/Inspector Name: �) /yv�
Phone: (--,/
Reviewer/Inspector Signature:
Page 3 of 3
Date: 6.
21412015 V5

x •
—IDW#vision of Water Resources
Faciliiy,Number. 0 Division of Soil and Water Conservation
y ..'
0
Other•Ageney -
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
[lesson for Visit: outine 0 Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: I Arrival Time: /Q - Departure Time: County —
Farm Name: ' CC, Owner Email: '
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 6,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current Design Current ._ Design " ;,Current.°
Swine Capacity Pop. Wet .Poultry Capacityn -Pop .: �. Cattle ,: ` CapacrtyPop�
p h
Wean to Finish
q
f t7b
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
Layer
Non -La er
Design Current
Dry Poultry Capacity Po .
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
'
Non-Dalry
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes EfNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes .EI"No ❑ NA ❑ NE
c. What is the estimated vohune that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P�Ko
❑ Yes 2310
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

lFacitity Number: - 7 Date of inspection: l C 17
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2'No ❑ NA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: {
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes 13'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ,EfrNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes fj1qo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PTNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PeNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12-no ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
nj�lo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
,e'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eno
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J2-1�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J�7po
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � F'W"
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �' o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA []NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Nuinber: jDate of Inspection: !1711VI
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
PNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
w
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
VjNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
(—]Yes
�TNo
❑ NA ❑ NE
Other Issues - -
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
V1 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[x No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
C yNo❑
NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TT
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question.,#) Explain any YES: answers�and/or;any additional recommendations or'any Other comments ,
Use 'dra�vings of facility. to`betier explain situations (use additional pages- as necessary)'::
711
0,70
5
i 113 //V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �G ?6 73,2
Date: ll z
l/4 014

,r
Division of Water Quality
FaCil�ty Number Division
Livision of Sod dand�Water Conservation
� O — Other Agency
e x.
Type of Visit
Reason for Visit
Date of Visit:
Farm Name:
Owner Name:.,
Mailing Address:
Physical Address:
Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Q(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time: O eparture Time: County: Region:
Facility Contact: �� /_ Title:
/
Onsite Representative: )olift zA6__/C/_
Certified Operator:
Back-up Operator:
Location of Farm:
Design ' Current
Swine Capacity' Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑Other e" -
0
Latitude: =
Owner Email:
Phone:
Phone No.
Integrator: &Zd
Operator Certification Number:
Back-up Certification Number:
Longitude: = ° = ' = «
ent' Design Current DesignCurr
Wet Poultry' Capacity Population Cattle _ Capacity Populahon
❑ Layer
❑ Non -Layer
Dry -Poultry "d Y
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
IIayi��ky
Numiber'of Structures ,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
No ❑ NA
❑ NE
❑ Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page I of 3
12128104 Continued

!Facility Number: / - Date of Inspection:/ Z
Waste Collection & Treatment
4. Is`siorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � _ 2 -3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). --
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �D No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[7No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
9No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
ZI No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
0. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes P No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 10 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes t No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑. NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [TNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
�" o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
j'—'
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
FNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
.!�No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAV MW?
❑ Yes
. f No
❑ NA ❑ NE
33. Did the Reviewer/Inspeetor fail to discuss review/inspection with an on -site representative?
❑ Yes
6No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes
ZfNo
❑ NA ❑ NE
Comments (refer to.question ff): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use; additional pagesas necessary):. - .
r9' sci
z.
q�
o�� � l� 0.( g �- o�� Plea �
-E0
o�-7 7 3 Sure
7, Z7 Z S 5 AS
(1 e � ip
Z-Zq 3
AIs
1 3 1 1 Z r 5 r �l%�7 d-
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Cam' Date: 2
Page 3 of 3 2/ /20II

* I
(F-acility'Number 3 j
vision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit -.0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitl`houtine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: aJ t s
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone: T'
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c = 1 = 4[ Longitude: = ° = 4 0 4i
Design Current . Design Current Desigh w Current
Swine Capacity Population Wet Poultry Capacity Population Cattle : Capacity'. Populat'on�
I❑ Wean to Finish �I
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other. . .
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Humbee'of Structures
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-�pade?
b. Did the discharge-ieach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a.past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
..
❑ Yes P<o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [,/No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — 77 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. -If yes, is waste level into the structural freeboard?
❑ Yes ZNo
❑ Yes jd'No
❑NA ❑NE
[-I NA El NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Z �2'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 Y 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes PNo
❑ NA
❑ NE
through a waste management or closure plan?
f
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes ZNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes P!rNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes eNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;?(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes lLJ No
X.
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
e
_Comments (refer. to question #): °:Explain°any YES answers, and/or any recommendations or any other, comments
Use drawings of, facility to better.explain situations. (use additional pages as necessary)•
Reviewer/inspector Name"
:° Phone:
Reviewer/Inspector Signature:
Date: l�
Page 2 of 3 12128Z04 Condnued

Ficihity Number: — Date of Inspection G (%
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P<O ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E2190 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes )?�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes eNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;TNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E3No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ,"No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ZJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 1 '2<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[:1 Yes ONo
❑ NA
❑ NE
lu f- /V D• S 7 1 n --akad o-F
G• ? ] 0.77 �fo r Jul C—)G .(0)
,�_
�u�r? f o dd Sat ( s a^-P6
I.s yeq j"
ee
z /Ord&
�-3
12128104

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
- - O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: g 30 ! Departure Time: County: tz- Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ++,, Title: Phone No:
Onsite Representative: r O kZ L PAJOLTU Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ a = Longitude: = ° = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Ed Feeder to Finish
11611Z
1 %J16
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: 0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑NA
El NE
❑Yes
ElYes
❑ NA
FNo
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

• Facility Number: 3 — Date of Inspection b
' Waste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El2 Yes
o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structur 2 Structur 3 Structure 4
Structure
5 Structure 6
Identifier: __C.A_6-wpj Z LAIr�� .3
Spillway?:
Designed Freeboard (in): ITS 15 • J 1 5'S
Observed Freeboard (in): 39 .S 1 Lt9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Lo [INA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir mental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
E] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs [:]Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Id No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
jj LACooru Z NEC-5 FNGJW6El1.. CVoQLVArZ# J O/- TJUI"Wag_ SCOPE . SCOv 9 PM Al otr .4GTZ�N jY
OWW.
Gdx v6 6O .Z vre,E 1(.A7bo- pw& R ow G4c. rep-+4Tzw 4/% oTHal, :9-mv Gap `r
?A,) VV A/ &JW AW-60 W-17V Zd 30 VA fit,
,j St D COP� G . d T C rd ,OW qu, �Al� OLS u3T#,TN So PA e3 Ir r9det-Exmi
o� 17�LR Z.C-�s L Fly D
Reviewer/inspector Name o Phone:
Reviewer/Inspector Signature: Date: •j dZ 0
12128104 Continued

Facility Number: 7, — % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
iyes
20. Does the facility fail to have a components of the CAW MP readily available? If yes, check
❑ No
El NA
El NE
the appropirate box. p ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V
Rain Inspections❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
L'J No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Id No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
'dyes
El No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
es
L�7 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
Wyes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ET/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0"No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,
�J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[I No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ZJ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number
4WDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Compliance Inspection
O Operation Review 0 Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: I I Arrival Time: II Departure Time: County: DUPCIV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: DA214 :ILI A k 3A.9ATdZ=CIL. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: F—] o =]' Longitude: [� o = ' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish l(� .ri 1
❑ Farrow to Wean
❑ Farrow to Feeder f
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other —
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey POURS
❑ Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Da' Cow
❑ Dairy Calf
❑ Dat Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes hio ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
Cl NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

t
A
Facility Number: 31 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: lA(.ao1) I 1A6&0;D f Z_ U►GaapJ'3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2. ! _ 143
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 2 No Cl NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E1 Igo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L'J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Cl No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) CO 5*
13. Soil type(s) 6
14. Do the receiving crops differ from those designated in the CAWMP?
El�J Yes
,�(
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
.J o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
l No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
C.AC,ow1 3 70LAC"&. LA GoOJ ?r GaMtlCtti- of Ash W%&LL `
t'j vc-oS 'JoR4C . 6 C-v W-VT4 S * w To Way t�L_ JPS , Se#4b Le rr& - Jf• LkV C4-
GAvcZEPt1�CtcEt ALoatr '^'4_rK cdPY o( s{.uoCGE SiIR.JC`P.
za1 N+�caJ wuP ws►-+- wcEo Ta aE ba E F00%- N E w �si�t.b AIJ� �r< JAB
o f A 64L N ae rZ E LAU ,
Reviewer/Inspector Name — -- -- _ s_rag i'ARaJF_t,l, � Phone:N 0 1 6 —114 S
Reviewer/Inspector Signature: Date: 3 [ ;u to
Page 2 of 1 12/.16/U4 c:onunuea

Facility Number: 3 L —i Date of Inspection 3 ]+ 06
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. Epp ❑ Checklists ❑ Design
g El Maps El Other
❑ Yes ICJ No ❑ NA ❑ NE
21 Yes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ej"�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
[2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?[%Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
2 Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
['�o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes U<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,/
L� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/
D o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a.N,) FL6vd k&C-T&C, PAPE(-j 066p ro f66 F—Q&dZ0 D, i15E of OFC —SSTE �l,ot�JMF1
06m % 13E 2�conoEa.
Page 3 of 3 12128104

S
* r
Q1:Drvision of Water Qttal
Facility Nutnlier i " Q Dwision of Soul an Ws
Q',Otlher' Agency
a
Conservation
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: 21�i? L Owner Email:
Owner Name: 4&VVIi ff�pi4-PZC-,0t' f / Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0Wfjbqmaw-z-o
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
0 Technical Assistance
0 Other ❑ Denied Access
P� � Region: `Le
Phone No:
Integrator: el 'Os''ge'<D
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= f 0 Longitude: 00= 1 0 1f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Other
❑ Other _
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: [i:j
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: /W D
Designed Freeboard (in): l qi5 _ %? X,
Observed Freeboard (in): 2 0 13 ? 20,
❑ Yes V�No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes % No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 10 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ILJ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
V(No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
V(No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/SIudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind ❑ Application Outside of Area
yDrifl
12. Crop type(s) 62tnj f14T7��
13. Soil type(s) F
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑ Yes
0 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
VNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
PrNo
❑ NA ❑ NE
M'h'Ztr6e
12
3. AAo4D
Reviewer/Ins ector Name ' xr �¢?'� Phone: �0' !Cs
P o B3= 3
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps El other
21. Does record beeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 9Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PfNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
/Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RTNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
/11 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ YesXNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
N
A ditlOrial`COmments'and/orsD, 7t a.
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12128104

Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0"Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ,3 Date of Visit: E
Permitted O Certifieed ©Conditionally Certified [3Registered
Farm Name
Owner Name:...r,���!I ya....91.JJ24a-k-].
Time:
10 Not Onerationai O Below Threshold
Date Last Operated or Above Threshold:
County: .��, ...4�h......-----------------
Phone No:
MailingAddress:..................._...................................................... _ .._..... _. _ _ _._._......_. _......... .. _..... _.._.._..
FacilityContact: ................ .......................... ........ ..... _----------- Title: ......—.... -------.... -......... -.... -...... ....... Phone No:---
Onsite Representative: z3.k...k1* C.4.$neul-Jik& l..i. Integrator:.. (,�.$�[�,............
Certified Operator:
Location of Farm:
Operator Certification Number: _ ......... -. .
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 66 Longitude • 6 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes �o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Jno
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes .12KO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Lallo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... ..�-._.... _.. `._� .... .. _.......................................... _._...... ....................... ..... I. ...................................
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection /
5.:Are thdre any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes j2fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
B. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ZZJ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes '0 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes '0 No
11. Is there evidence of over application? If yes, check the appropriate box below. Oyes ❑ No
❑ Excessive Pon
ing jZf PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
13. Do the receiving crops differ with thole designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
'0
❑ Yes
b) Does the facility need a wettable acre determination?
.10No
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes O No
16. Is there a lack of adequate waste application equipment?
❑ Yes No
Odor Nsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
rA
❑ Yes XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes/No
Air Quality representative immediately.
WCommeats (refer to questtod#) Ezpla�n any YES answers and/or any recommendations or any�oter, comments. _ ':
�Lise dr�rvrngs�bf facility to better exglarn s�taatrans. {ase"additional pages as necessary) � ❑Field Copy �❑ Final Notes � n
a
' T
'.".�""�'.'...�-_.-
Reviewer/Inspector Name(j
Reviewer/Inspector Signature: Date: r5�i Q
12112103 Continued

Facility Number: _ Date of inspection
Rle uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below.
Oyes
❑ No
Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
V'No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does €acility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
OYes
❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONO
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
ONO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ONO
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. .0Yes ❑ No
❑ Stocking Form Ocrop Yield Form Rainfall A Inspection After 1" Rain
JK120 Minute Inspections ❑ Annual Certification Form
3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
� s�uo� 5����y �✓��as % ,ems yDeN� �� L�,v A(j_
SrR� &*-f 7K�•
/IlC L %,�eo z,o rg-aNf & f R,4,e, C�iPF�P
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1q*J0 �eA2,C,4 r-7a0 � � ✓�r� r5 P�v �.ed v�'a F•erv� s
l ' i'�i✓ ©v�Q /¢/�i�L�1'?zaNS
! OF I#
&o -�
12112103

Type of Visit r Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
O Permitted © CC1erttiifi�ed�� [3 ConditiGnnally Certifieed, ; © Registered
Farm Name: �B'LF_ T<//i`�klln
Owner Name: "QB OU N C1 �L9b-rkr-C K �
Mailing Address:
Time:
Date Last Operate r Above Threshold:
County:. _uALz,J
Phone No:
Facility Contact: 'Title:
Phone No:
bRC�LSBDROnsite Representatire:�0�pera or:
Certfied
Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry © Cattle ❑ Horse Latitude 0.0 OK Longitude
:Design ° d_Current - Design Current- w Design . '. Current '.
-Swine.elation . ;iPoaltn _ _ Gapactty-PaPulaton Cattle .. Ca acttv,-.Pa ulshaa
Wean to Feeder ❑ La er T ❑ Dairy
to Finish ` ; ❑Non -Laver I I Non -Dairy
_.
Farrow to Wean w P
[3Farrow to Feeder ❑Other 3
❑ Farrow to Finish Total Desl l C8�aCttj' r.
❑ Gilts
❑ Boars - Total SSLW
Number of Lagoons 4 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Feld Area"
,Holding Ponds ! Sohd Traps . - ❑ No Liquid Waste Management System
' a
Discharees & Stream l-mimets
1. is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Laizoon ❑ Spray Field Cl Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation?
❑ Yes ;jNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spitlway
❑ Yes �[ No
Structure t Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier: 01 I� 2 4-3
Freeboard (inches):
0510.3101
Continued

Facility Number: —r7 r, I Date of Inspection VNO
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ElYes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �[J No
(If any of questions 4-6 was answered yes, and the situation poses as
immediate public Health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
12. Crop type ( ' O O UI) t-� FA T 7) V
13. Do the receiving crops differ with those designatid in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes A No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes6No
No
c) This facility is pended for a wettable acre determination?
❑ Yes
15.
Does the receiving crop need improvement?
❑ Yes
Pf No
16.
is there a lack of adequate waste application equipment?
❑ Yes
�JNa
Required
Records & Documents
iNo
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
��No
/E No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(VNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments, (refer to;o#guinmather;omments
Use drawengs of faciltty tii better explaeat sttuationsjuse additional pages as t-ecessary) ❑ Field Copv ❑ Final Note_-
_.
i�- t1 E(L As� Ot,,J 0c, F2NL RM< t rRorn
�1AS le>C_C7o0F_ rod I r4F, (24ARF�� LR2zr }�r
5-� t,�i�sz F �'r 'ZFrrzOnJ PLA-1 �FEp S fo tS�zDontF
/-CASs rpom f H
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: I dILL:-]
05103107
Continued

Facility lumber: — Date of Inspection
tlor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
ZP
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ANo
❑ Yes ( No
❑ Yes No
❑ Yes V No
❑ Yes PNo
❑ Yes ❑ No
:Additional Continents and/ar`br2,wings.
A,
Az-
4kv&- aEF-0 U5r:0 r©R MEOZOW
P'tRPf:'SE-S, P:;7a NEE ns ?'0 f,3F- +Qz:s(bSFD DF
05103101

M
(Type of Visit lompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit I Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number jDatcorvisit.:
4—permitted [3 Ce 'feed [3 Conditionally Certified 0 Registered
Farm Name : ............ ..........��.5.............. .�.`....... .... �C._
of V I Ti.,.- 1 i -
O Not Operational O Below Threshold
Date Last Operated or Above Threshold:.......
County :.--...............
OwnerName: ................................................... ....................................................................... Phone No:
Facility Contact:
Title:........
Phone No:
MailingAddress:........................................................................ .
Onsite Representative:. !�Z'!ti^„ �t 1AH�c �(IL� `T�. ".. g
'F...................................................................... me rator:..........................
Certified Operator: ........................ ......................... ...................... . ...................................... Operator Certification Number:....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 = 64 Longitude 0 ' "
Design Current Design Current Design Current
Swine Capacity. Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish y3 Z JEI Non -Layer I 1 ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total DeA Capacity
❑ Gilts
❑ Boars T©W SSLW
Number of La Dons Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
g .- - -
�.._-...
Holdtng Ponds 1 Sohd Traps` ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water or the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes ANO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes V,No
❑ Yes No
01/0l/01
Continued

I Facility Number: j — "`` Date of Inspection 1 printed on: 1 /9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes S40
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ENo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes E(No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes UNNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNO
C wV Vj
C-5-)� w`J �-�-e�-
Su b v�
5100

Facility Number: — Date of Inspection
Waste Collection & Treatment CNo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Luc ure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......... ........ ............. ................. ......... ........ ........ ............ ............. ...............
Freeboard(inches): ..................fZ.�............... .................................... .... ................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes �No
seepage, etc.) '
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes gj No
(If any of questions 4-6 was answered yes, and the situation poses an \
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement? �es ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence ofKer application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes *0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes No
c) This facility is pended for a wettable acre determination?
❑ Yes No
15. Does the receiving crop need improvement?
❑ Yes ;<No
16. Is there a lack of adequate waste application equipment?
❑ Yes ,<No
o
onn ary?Ej
Required Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
DdNo
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
to
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ElYes
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J!fNo
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RW6
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�&o
26.
Does facility require a follow-up visit by same agency?
❑ Yes
P&o
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�o
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
N0
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
UNo
01/01/01
Continued

JeDivision of Water Quality /
O Division of Soil and Water Conservation f�
O Other Agency
Type of Visit (Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number -
Date of Visit: Time: � Printed on: 7/21/2000
O Not Operational O Below• Threshold
flir
Permitted Certified [3Conditionally Certified [3 Registered Date Last Operated oZq
love Threshold:
Farm Name YC �� y........C A-YIyL 1 County: .klll!..........'..........
..............................\..................................
Owner Name: .....Jb�`'�.............................. �. .a .................. Phone No:.......................................................................................
�...
�1 j �^
Facility Contact: ..... 17 ..................� 1 a?PP�f.�....... Title:.........11!!�Y13'I l.......................... Phone No:...................................................
MailingAddress: ......................................................................................................................................................... ........................
Onsite Representatives .,..,.1 3.1 •,.. . {`/ILr integrator: ,,,.•,,,, �5 . K-W
... ...
Certified Operator: ..... Ji,r........................ ..�f a�...4........... Operator Certification Number:.� .......
Location of Farm:
I _ Imo'
�L5wine []Poultry []Cattle []Horse Latitude �' �` ��� Longitude
Design Current. Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ) ,Z� �- ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons [[—:]Subsurface Drains Present ❑ Lag—n Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream I.myacis
1. Is any discharge observed from any part of the operation? [-]Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'' ❑ Yes ❑ No
h. If discharge is observed, slid it reach Water of the State'' (If yes, notify DWQ)
c. II'dischargc is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systent? (If yes, notify DWQ)
❑ Yes ❑ No
N/f
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P"o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes cq Vo
Waste Collection & 'l'reatmcnt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes DNo
StrUCttuure Siructure 2�t Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures ob erve . (ie/ trees, severe erosion, D Yes (XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes C(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
jk No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
Rg�No
12. Crop type _00� �%
13. Do the receiving crops dif r with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
&No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
&�No
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
K No
15. Does the receiving crop need improvement?
❑ Yes
[ANo
16. Is there a lack of adequate waste application equipment?
❑ Yes
0,No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
4No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) -
❑ Yes
&No
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
19,No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
%No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[ No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
tNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yeso
�: �`�io yiolatigris o. deficiencies were . . . .during �his:v... ...will . . . I .Rio l`u... . .
icorresaoridence: a'�out: this visit. ............:::::::: • : • :.: • : • : • ::::::::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
00 `
��Y✓t 1•L (J'c/���.�t1�� �%/��J 111�D�. -�/.l%�ia� 100fx�
Reviewer/Inspector Name
Reviewer/Inspector Signature: .Z_1 _ v-10.0d__ `19 l Date: 5100

Facility Number: — Date of inspection Printed on: 7/21/2000
r -
Odor Issuos
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes K No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Jivo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ( 0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 3r0
Additional omments and/orDrawings:
AL LWI
GU.��o�
U) U. P d&--es sh"7� 4- t '5 .

DivLSion of Soil and Water Conservation =' Opera4on Review x
© Division of Soil and Water Conservation- Compliance lnspecEion
� Division of Water Quality - Compliance Inspection f y
T Otber:Agency Operation Review "
[0-Routine O Comolaint O Follow -ern of DWO inspection O Follow-uo of DSWC review O Other
Facility Number I
Date of Inspection Time of Inspection ?Cj 24 hr. (hh:mm)
Permitted 0 Certified Conditionally Certified ❑ istcred ❑ of O crational Date Last Operated:
C1� 113-1 �f''' Cannty:
Farm Name: ..C..;.................... Zt
Owner Name:...`;�.G .... 1... '�5 �"�.. '. Phone Nu:......•....................................................................
Facility Contact: .................................... ...............
Mailing Address: ..
Title: ......................................... ....................... Phone No: .....
Onsite Representative: ,.. 1�!..-..�?� .............I.. ...... Integrator:...,.'rCi..........................................
Certified Operator:................................................................................................................ Operator Certification Number:........................................
Location of Farm: _ i t r n r
..............._.-...................._._......,.....................................................................-----....---•........................................................................
Latitude 0 �� �.c Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ID Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars EE Total SSLW
Number of Lagoons Subsurface Drains Present ❑ Lagoon Area KrsprayField Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges &: Stream I-mpacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. Il" discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in eal/min'?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
ldentifier:
Freeboard (inches):. �"
Structure 3 Structure 4 Structure 5
❑ Yes .(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes NNo
❑ Yes (KNo
❑ Yes [>ONo
Structure 6
1/6/44 Continued on back

ility�ll�tnber: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or'
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
0
❑ Yes
�No
❑ Yes
j CNo
KYes
❑ No
[]Yes
P$No
❑ Yes
P(No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
I' No
11.
Is there evidence of over application`? ❑ Ponding ❑ Nitrogen
❑Yes
KNo
r�.... �Gt-`1.r`1..l.SC'..
12.
Crop type ...._ f................... r�............. ............ ........... ..................... ....................................................................
t.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
WNo
15.
Does the receiving crop need improvement?
❑ Yes
KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
%No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[�(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
d No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
W�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
0 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Wo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
JXNo
0: N�o.vialations:Or. defciencies .were noted. tiuirink Ais:visit:. "u' wavill.receive nor further .: .
eorres'D ideh&' abo6f this visit.. • . • . ........... ... ... .... ..... .
Comments (refeir to question#): Explain any YES answers and/or any. recommendations or any other comments :=_- --
Use drawings of, facility to better -explain Situations. (use additional pages as necessary)
Reviewer/Inspector Name _
Reviewer/Inspector Signature: �C_k _ Date: 1 jtoI 11/6/99

f-
�I
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine O Complaint O Follow-ue of DWQ ins action O Follow-up of DSWC review O Other
Date of Inspection
Facility Number �—�
Time of Inspection ' �Q - 24 hr. (hh:mm)
0 Registered 13Certified © Applied for Permit qPermitted JE3 Not O erational Date Last Operated: ....................
Farm Name: County:.....................1...................................
Owner Name: ... � ��CA .. Phone No. ' ~ �`' 1� � `` rr
1... ....................... I .........
Facility Contact: .............................................................................. Title:................... Phone No:
�/�
Mailing Address: .... ..17 ...... .. .1 �....�0 �'��r.... l�l. .dam. ....... ...................... ..........................
..
OnsiteRepresentative:..!^hQY............................................................................... Integrator:.... ` .... `' . ........................
Certified Operator:................................................................................. .... Operator Certification Number;
1,ocatiog Vf Fa
�.�,r,......... .... a..c�.................................................................................. . .
Latitude 1 01 , 1 J96 Longitude 1 j• LT i, 1 44
'Design Current
Design Currexit ...DeCxlrfcxxt
Swuxe_ CapacityPopxilation
'Poultry
Capacity Po{iulation Cattle „ Capacity PopWatxon
Feeder
- ❑Layer
❑Dairy
o Finish �3'd
❑Non -Layer
❑Non -Dairy
KFarrow
Wean
t - o
o Feeder
❑Other
b k map
❑ Farrow to Finish
a:
Total Design Capacity
❑ Gilts
A.}.
;•
❑ Boars
r.
Total SSLW h
k
Nxtmber of Lagoons / Halcling Ponds ®
❑ Subsurface
Drains Present
❑Lagoon Area
Spray Field
L] Area
❑ No
Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yea�k s% No
c. If discharge is observed, what is the estimated flow in gal/min? l A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Rf No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes E�No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes U4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. - Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes C(No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Dd No
7125/97

r"i " Facility Number: — r? 1
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... n
Freeboard (ft): ..........�a�.:. ............... •'••`�......................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop typeL.`'....{............................................................................... .......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
wMr
aY�n �►. Gt�c�� t��-.tic l_.� . �rP.r�
❑ Yes j(No
❑ Yes N No
Structure 6
❑ Yes dNo
❑ Yes M No
UfYes ❑ No
❑ Yes 0 No
❑ Yes VNo
...........................................
[XYes
❑ No
Cl Yes[TNo
❑ Yes
ONo
❑ Yes
19 No
❑ Yes
[9No
❑ Yes
No
gYes
❑ No
Cl Yes &No
Yes ❑ No
❑ Yes P� No

Date of Inspection 47
Facility Number 3 'j
Time of Inspection 1i= O 24 hr. (hh:mm)
Registered 12 Certified 13 Applied for Permit [3 Permitted JE3 Not Operational Date Last Operated:
Farmlame: ........L.�.......T--! —..... Gri!r ....................................... ............ County:........ i.cDlty..................................... .......................
T 1
Owner Name: ....... b.A'VkA......ii,..... �'� ��... .� ...................................................... Phone No:..C�IIQ�..��.-.�� eoo._......9_..........�q$ �
Facility Contact: ...A.61 .r.....��.ti.1. Af ► Y........................... Title:..........Ql!)i1*..........�...q..................... Phone No: rtl¢ .Z`�ts..-D?.��............
MailingAddress:.... i3i......!`.4 x.....i .�f! 5�........................................................ ....... WAY-s rcJ Nic..................................... :�.........
ll II �....... r...... .
Onsite Representative:.--................................................. Integrator: .......... D.t] .. .
Certified Operator :........ ..- ay.4............... Operator Certification Number:.... P.160 ......................
Location of Farm:
.J.�:...��.... 0A.. ayn�r .,..:.n.�o�: umQ.� GS....4.....�4n, ... t a�,..G.tr, ►�.� . ..1.,.. Ia... a...FS. ..... ... r.N...�a.. . ..-.�.unn....r...�� Ift�. ,SA....-.[ ��.f...�n.....-.(�...�.�....`�u.�................t7�...:SR��.il.......:�r.rm....,:s....��
f ------ 10 f ie --cadan Wes
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle , Capacity, Population
❑ Wean to Feeder JE1 Layer I ❑ Dairy
Feeder to Finish JE1 Non -Layer IEJ Non-Dairy
Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons / Holding Ponds
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Subsurface Drains Present JIL7 Lagoon Area IRYSpray Field Area
No Liquid Waste Management System
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Waicr? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in ,aUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenance/i mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
RrYes ❑ No
❑ Yes JdNo
❑ Yes 1� No
❑ Yes IS No
❑ Yes 1�] No
❑ Yes P�No
❑ Yes No
❑ Yes No
❑ Yes NfNo
❑ Yes XNo
Continued on back

- ,11
Facility Number:
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding. Ponds Plush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ..................... ............. . L.......... ...................................... ..................................
Freeboardtit): ..........k................. ter............................................... ...................................
10. Is seepage observed from any of the structures?
❑ Yes V] No
❑ Yes 4b No
Structure 5 Structure 6
❑ Yes Qf No
11. Is erosion, or any other threats to the -integrity of any of the structures observed?
❑ Yes
J9 No
12. Do any of the structures need maintenance/improvement?
KYes
[:]No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
"Yes
❑ No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
r� No
(If in excess of WMP. or runoff entering waters of the State, notify DWQ)
15. CropY
type .....................Irs ................. soy ..bc lux............. ........... %Y1ZV. ......................---.SL'
it... f0.TJl1........
J
.....................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
IT Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
E9 Yes
W No
19. Is there a lack of available waste application equipment?
❑ Yes
IM No
20. Does facility require a follow-up visit by same agency?
`Yes
❑ No
21. Did Reviewedlnspector fail to discuss review/inspection with on -site representative?
❑ Yes
®,No
22. Does record keeping need improvement'?
64 Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? 5(Yes El No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 91 No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes t No
[3,No violations or defiiciencie's.were noted -during this,visit.-You'will receive no further
Orr&Ondeike A out this'visit:' :.
Cornmenti'(referio question #) Explain any YES answers and/or any &nm reeorndations or any, other comments
Use drawrr gs of Eacrhty to better explain srtuattons (use additional pages as necessary)
.. a
M. Ero tit$_ Comm or, 1mv o- - t&yon # y 6hovid le A(W wfu. 4ay aJ rese-4d. G�as�1a.
in S�LN 1n W0.Igr d1i vGYS i0►1}} S itpti l� be lr{Joir_`- 1 -0 aCMA `1 2 (rt�t� �_T Gj t7r I
5Skov tj e ep'ffc C3 atJ 114, a l'Y J ((�`f J WNW W (,t)1 t't^ Clay `� a� J tJsGSC .$Art CU^eca
n !m owls s(ns� �t✓ �se�r�ed • `�"�
�• iag
i�. 3[3ertat�la, i�tosftcl � itn�r�tri ,,11 ff L -,,- _1 1 �,,,,,,��
oacn ff VWh e4rS S�aNW be 11a6fed t� fbW ` S. �� A 93;� 5"-'` ptc
oar, des; 1 i�tould /ae �� C�- ' lut. �3, aY On reco�z ornsr`�{.7125/97
Reviewer/Inspector Named
Reviewer/Inspector Signature: Date:

•
•
Site Requires Immediate Attentio : ' "-
Facility No. -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: , 1995
Time: %
Farm Name/Owner: 1GA'P-r14
Mailing Address:
County: 1Jp
Integrator:
On Site Representative:
Physical Address/Location:
m3g_�_
_ Phone:
Phone:
e>;r )- 1r1iRv-1
ROM
Type of Operation: Swine V Poultry Cattle
Design Capacity: DAP + Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° - Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon havS.Rqicient freeboard of 1 Foot + 25)year 224 hour storm event
(approximately 1 Foot + 7 inches)VeNo Actual Freeboard. _Ft. InchWas any seepage observed from thn(s)? Yes o io Was anv erosion observed? Yes r N
Is adequate land available foM�_�
Yes or No Is
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria?
Ye cover cro adequate? Yes or No
200 Feet from Dwellings? es No
100 Feet from Wells?' Year No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
cc: Facility Assessment Unit
Sign
Use Act chments if Needed.

•
•
Site Requires Immediate Attention.
Facility No
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO7 SITE VISITATION RECORD
DATE . v-77.
1995
Time.•
Farm Name/Owner:1-�/
Mailing Address: `
County: L/
Integrator- /tCleI Phone: �%-
On Site Representative: U Phone:
Physical Address/Location:,K
Type of Operation: wine V Poultry Cattle
Design Capacity: 6 W Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:" Longitude: 7? �' 7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �Ye�or No Actual Freeboard:',�Ft. Inches
Was any seepage observed from the laa,,00n(s)? Yes o NOWas any erosion observed? Yes No
Is adequate land available for ray? Y or No Is the cover crppradequatte? � r No
Crop(s) being utilized: - — ��� � L W
Does the facility meet SCS minimum setback. criteria? 200 Feet from Dwellings? es.&9r No
100 Feet from Wells( Ydbr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or -No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
-� Inspector Name
Sign
cc: Facility Assessment Unit Use Attachments if Needed_

E
Site Requires Immediate Attention: 22
Facility No./-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3 , 1995 7 77
Time: Z '. 10
Farm Na
Mailing
County:
Integratc
On Site ]
Physical
Type of uperation: .iwine L�— roultry t�atue
Design Capacity: �L 0 q (O Number of Animals on Site
2SOd
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3¢ ' S5 ' 1:9-S" Longitude: -1-7 ' 5-7 ' Elevation: Feet .
t o Circle Yes or No _10.0
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event .
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: -1_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or® Was any erosion observed? Yes or(No)
Is adequate land available for spray? &orNo Is the cover crop adequate? Yes r No
Crop(s) being utilized:' rn
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
Wra
100 Feet from Wells? Yes or No .
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes O(So)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man --made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes
Additional Comments: .� l L rl 'S
h 2�Q5 i r r; -;A 2G cAJK
2 C�
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed_

17J
0
Site Requires Immediate Attention:
Facility No.3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 33 , 1995
Time: Z ��
Farm Name/Owner: 7A ►7 er 1 0:�2f rj
Mailing Address: PD
County:
Integrator: Mor4h,
On Site Representative
10
-241 5 V " I 1'e Z33
Physical Address/Location: �� 4 � 5 V+ [ [C
% (CI59 . r 6 alA+ rnn iv Icl g 1
Phone:
Phone: 4S 4-C(
SDI N S m 45 Urn on ID
Type of Operation: Swine Poultry J Cattle
Design Capacity: 4 F q(P Number of Animals on Site: d
DEM Certification Number: ACE a DEM Certification Number: ACNEW
Latitude: 3A ° S5 ' Longitude: 11 ° _S7 - IElevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) es r No Actual Freeboard: .2_Ft. (a Inches
Was any seepage observed from the lagoon(s)? Yes of Vo Was any erosion observed? i br No
Is adequate land available for spray? eor No Is the cover crop adequate? VorNo
Crop(s) being utilized: Corti
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o N
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o&
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (v lumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes No
Additional Comments: Will Swi +h -b LVn ! i N o►'bT�
M;,►or - eras t'cw of hed&C )t'r e UIYF 1- sir�nP_.
1 w en l r 6 2 k•nn --o 2C e W1 Sf"e K •1 o z#'rcc 16-.
i L /ijz L.
Inspector Name
Signature ^
cc: Facility Assessment Unit
Use Attachments if Needed.