310127_INSPECTIONS_20171231

OP,
NOHTH CAHOLINA
Department of Environmental Qua

Date of Visit: Arrival Time:® Departure Time: 2 ` 1 County: DGD'i; Region:
Farm Name: 4n?2 Z" 64�J� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number: aiq�z_�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Finish
Design C«urrent Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dai Cow
Feeder
Non -La er
Da' Calf
o Finish
�;/S
Da' Heifer
o Wean
o Feeder
o Finish
E
Design C**urrent D Cow
D , P,oul, C•a aci P,o , Non-Dairy
La ers Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
10ther
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 ONo ❑ NA ❑ NE
❑ Yes EalNo
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
0 Yes
[ENo
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ins ection: /2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej <No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ YesF�r<o ❑ NA ❑ NE
Structure l 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 6No ❑ 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 MeNo ❑ 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 [] 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 [a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes 0No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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 ZNo [DNA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes La"N'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ETNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
(ZINo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
E�'%
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ NA
❑ NE
the appropriate box.
❑ WUP El 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 1" Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes 21-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

Facili Number: - ;2 7 Date of Inspection: /2
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Too ❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑'No ❑ 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
[R o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
2 "'o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes PN ❑ NA ❑ NE
❑ Yes [R o ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
✓ No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comrneats.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatun
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: 9,Cbompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: e6ioutine 0 Complaint 0 Fallow -up 0 Referral- 0 Emergency 0 Other 0 Denied Access
Date of Visit: j / Q�j - Arrival Time: Departure Time: County: LP JJ _ Region: �r
Farm Name: m]'g Zep &/Q4 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �j'1g; rs
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 150
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
et WPouitry C+apacity Pop.
La er
Design Current
Cattle C-apacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish.
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Farrow to Finish
Dr P�oultr Ca aci
La ers
Pao
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Qther
Other
Discharp,es 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 .ETNo ❑ NA ❑ NE
❑ Yes CEf-No
[:]Yes ❑' No
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
[:]Yes � No ❑ NA ❑ NE
[:]Yes 2-No ❑ NA ❑ NE
Page I of 3
21412015 Continuedl

r
,Facili!�i Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [�do
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 2-No
❑ NA ❑ NE
Structufe I 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 -ffNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes _Q-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 �1 o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 2No
❑ 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 Q<o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Q - 'o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes L' 1 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
P-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�a"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
DNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�jNo
❑ NA
❑ NE
Comments refer to uestion # : Ex lain an YES answers and/or an recommendateo
(.. a ) 1' Y .. YY . ns or any other comments"'
facility P (
;Use drawings; of facile to better explain situations use addithonal a es as necessa
wA.
%
<
71AIX- is 3s ��� �� 2. L3
C�
Reviewer/Inspector Name
Phone: lQ
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12126104 Continued

Type of visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: G eparture Time: O County: Region:
Farm Name: a�_ �l%f�ij _l Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: E)e�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: r
Certification Number: 11911^1
Certification Number:
Longitude:
Z'Feeder
Design Current
Swine Capacity Pop.
Wean to Finish
I
Design Current
Wet Poultry Capacity Pop.
I Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
lNon-Layer I
Dairy Calf
to Finish
Design Current
D . Ploul C•_a aci Ro ,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
ILavers
Non -Layers
Pullets
Gilts
Beef Feeder
Boars
Beef Brood Cow
Qther
Turke s
Turkey Poults
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)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes Vo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment _
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes EfNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4. Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C3,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? f
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes effNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2]�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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes _0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes EyNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes J:3No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes „;7[''No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E]Ro
❑ 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 [i]'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 ;ZNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe it. ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No
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 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ZfNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA 0 NE
❑ Yes IdNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes )z No ❑ NA ❑ NE
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 ft Explain any YES answers and/or any additional recommendations. or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
kok our
(ola3�-
Reviewer/Inspector Name: 1 Phone: 1 7
Reviewer/Inspector Signature: Date: /
Page 3 of 3 14 14

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 01koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: ` Q Departure Time: County:2
Farm Name: E� I c- f rye Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: zl�� j. I L J L,
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Region:
Integrator:
Certification Nu er: I as r3
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
11 �Turkeys
Other
Other
Turkey Poults
I 10ther
DischarEes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes.6 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes Z] No ❑ NA ❑ NE
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 DWQ)
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 kTNo
❑ Yes No
❑ Yes �No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Faci1ity Number: jDate of inspection:
Waste Collectioq & 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 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 )allo
❑ 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 ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 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 E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L"No ❑ NA ❑ WE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 0 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 Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ,DNo ❑ NA
[] Yes E2'No ❑ NA
[:]Yes ❑'No ❑ NA
❑ Yes J;3No ❑ NA
❑ Yes ,rNo ❑ NA
❑ Yes oNo
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O No
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�rNo
❑ 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Eno
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ecdon:
24. Did the facility fail to calibrate waste application equipment as required by the permElit. Yes El"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0No ❑ 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 E] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Pno ❑ NA ❑ NE
❑ Yes Z�No ❑ NA ❑ NE
❑ Yes 21"No ❑ NA ❑ NE
[:]Yes ONo ❑ -NA ❑ NE
❑ Yes ZNo
❑ Yes e No
❑ Yes JzNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
ReviewerllnspectorSignature: Date:
Page 3 of 3 21412011

n
Division of Water Quality
FacEL� Number � a "O Divtsion of Soil and:Water Conservation.,
u
..,k..:� Other:
gency '"
Q
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access,/ -
Date of Visit: Arrival Time:Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 251 _1
Certified Operator:
Back-up Operator:
Location of Farm:
Region:
Phone No:
Integrator:
Operator Certification Number:
1 Y3 n5.
Back-up Certification Number:
Latitude: = c = ' Longitude:
w Design Current. Design Current: .-
Swme Capacity `Populahan Wet Poultry " apacityPopu qn Caitle
C _
laho
❑Wean to Finish 1.10 Layer ❑ Dairy Cow
7t ❑ Wean to Feeder ❑ Non -Layer ❑Dai Calf
,. El Feeder to Finish ❑Dai Heifer
El Farrow to Wean Dry Poultry El D Cow
. . ❑
n Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex 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?
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
ber o
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 )ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes )ZNo
❑ YesrNo
❑ NA
❑ NE
❑ Yes
L? No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Waciliti Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): --f-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J:j 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 2fNo
❑ 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 J�J"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 1; o
❑ 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 ,,E] Flo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes C -No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �o
❑ 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 O'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes A!j No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes',0-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 E No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes��o ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ 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 ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

4`
Facility Number: — Date of Inspection
Required Records & Documents
1,9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUP [] Checklists ❑ Design', ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box -below. ❑ Yes Q No ❑ 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 &No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes , dNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? - ❑ Yes );314o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? Yes, No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes f. No ❑ NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑,�cs �Vo ❑ NA [I NE
. 1
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ yes PNo ❑ 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 concein? ❑ Yes 7No ❑ 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 O'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 ffNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? - ❑ Yes No ❑ NA ❑ NE
Additional Commentsanillor Drawin s. `-
yi La zon Wa C(. Seedeg.
�.r
�r
Thaalc t row e 0;`
l dlq to
Fall,
Page 3 of 3 12128104

Facility Number_7
of Water Quality
of.Soiland Water`:Conservat�on JY
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: � /0 Arrival Time: d, Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e Longitude: = e
_
>� Destgn Current „ ,� Design Cui rent
Design' @urrent
Swine . d' ". Ca aei' Po ulahony� -"Wet Poul Ca aci`Po ulattgn, 'Cattle,
ti Y
.mP.-, �3 P .= x -_ . �.®..._ >p !3 wow p�
Ca aei Po ulation .
PP...
❑ Wean to Finish " ❑ La er ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer I I ❑ Dairy Calf
El Feeder to Finish y• . Y ❑Dai Heifer
❑ Farrow to WeanD IMF ❑ D Cow
*-ry
El Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish' ❑ Layers
❑Beef Stocker
El Gilts ❑Non -Layers ❑ Beef Feeder
❑Boars v ❑ Pullets ef Brood Co
❑Be
-H ❑ Turkeys
_ , _ ❑ Turkey Poults k
_
❑ Other ❑Other '�` 'Number of Structures:
r,
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)
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 1 of 3
❑ Yes _12No ❑ NA ❑ NE
❑Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
eNo
❑ Yes
N
❑ NA
El NE
[I Yes
�J No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
IF
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:
❑ Yes ,'No ❑ NA ❑ NE
❑ Yes JNo ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo
❑ 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 'PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,2No
❑ 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 WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo
❑ NA ❑ NE
maintenance/improvement?
,�
IL . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,YJ 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
l2. Crop type(s)
l3. Soil type(s)
M. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
01
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer.to question #}: Explain any YES answers and/or auy--recoinmendations,or.:any otlier comments_"
Use. drawings of facility to better explain situations. (use additional pages as necessary):
•
T
Reviewer/Inspector Name Phone: -
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )2 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P'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?
ElYes
/P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�Ko ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes VNo ❑ 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 OrNo ❑ 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 El Yes LdNo ❑ NA [I NE
General Permit? (ie/ discharge, freeboard problems, over application) ll!
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes <o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes 0No ❑ NA ❑ NE
AddateonalComments andluo�
Y�_
o� s
I
y /�0 43 � � �� #u'V' e xPccle"J
S
aIds -//0 e cad
Page 3 of 3 12128104

..'Division of Water Quality
Facility Number `j� 1 O Division of Soil and Water Conservation V
O Other Agency
Type of Visit O'Cbmpliance 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: �' Departure Time: County: Region: G
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: 6�. fK_$2
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = 0 0 ' 0 " Longitude: = o = ` [:�] '
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
[1 Beef Brood Cowl
Number of Structures: E]
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 L2'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ YeslNo
❑ NA
❑ NE
❑Yes
eJNo
El NA
El NE
12128104 Continued

Date of Inspection
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes PKo
❑ NA
❑ NE
Struct re 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 Z) 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 PNo
❑ 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 [}`No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [2-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 E;;'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes UlNo ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [A/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
u o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0"N0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[2-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name I A10 Phone:WtP'-15 4 W, _IC l
or
Reviewer/Inspector Signature: 0Z Date: v (1
Page 2 of 3 12128104 Continued

Facility Number-1— Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EffNo ❑ NA ❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z 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
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[?fNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EZN0
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
YNo
❑ 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
ff No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E714o
❑ 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
2rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
YN o
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
iNAZ
'/ 414
� GG�
12128104

O.Di. on of Water Quality
Facility Number, Q Division of Soil and.Water Conservation
D Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit / outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !i Arrival Time: Departure Time: County: _L Region
Farm Name:�ILA Owner Email:
0-1
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = , = „ Longitude: = ° [--] ` =
Design ' Current . ' Design Current
Swine Capacity. Population Wet Poultry Capacity Population
ElWean to Finish 11❑ Layer
❑ Wean to Feeder 10 Non -Layer
CaTeeder Finish
❑ Farrow to Wean Dry Poultry.
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars r
Other
❑ Other } w
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FI
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)
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 1 of 3
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,!1No
❑ NA
❑ NE
❑ Yes
_P']Vo
❑ NA
❑ N�
12128104
Continue,,

Facility Number: — Date of Inspection 2 Z
Itc uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E ❑ NA ❑ NE
the appropriate box. El WUEl Checklists Designs El ❑ Maps 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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes [ *o
/�'No
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑&o
El NA
El NE
Other Issues
j
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes J'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 PNo
❑ 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 fiTNo
❑ 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
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes 'dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
ID- y
1,7
.3 a 7/a6 )t' �
l
Page 3 of 3 Ql� 6 1 !7_9,'2X 12128104

Type of Visit .ref Compliance Inspection
Reason for Visit 011'outine O Complaint
Date of Visit. I /. /",r3e—r Arrival Time:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
O Operation Review O Structure Evaluation O Technical Assistance
O Follow up O Referral O Emergency O Other ❑ Denied Access
�eparture Time: County: Region: �f��
�1'rk Y' C r /--, Owner Email:
Facility Contact: Title:
Onsite Representative: f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Boars
Other
❑ Other
0
Latitude: =
Phone:
Phone No:
Integrator:
Operator Certification umber:
Back-up Certification Number:
="
Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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?
❑ Yes ,,2rNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes El No
❑ Yes ONo
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
12128104 Continued
I

Facility Number: Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ 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): F
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes .2NO
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes J:j 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 �INo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ❑ No
El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
j
9. Does any part of the waste management system other than the waste structures require
❑ Yes P-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes PNo
❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes L3 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
eeJof 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 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes D-No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes ,jallo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ; No
❑ NA ❑ NE
Reviewer/inspector Name - �vf ���C.�•`� � y Phone: 79: —�
Reviewer/inspector Signature: Date: �` G
1212VD4 Uonftnuea

Facility Number: —lZ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;3'1V'o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. /
ElWUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P,1qo ❑ 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 ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ 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
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
23 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZfNo
❑ 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
JgNo
❑ 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
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments -an dlor Drawings:
d--
12128104

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
© Permitted 13 C rtified 0 Conditionally
Certified © Registered
Farm Name:
Owner Name:
-Madmg Address:
Facility Contact: __ ... ...___ __W Title:
Onsite Representative:�Q`
Certified Operator:..
_.
Location of Farm:
Tune:
Not Operational O Below
Date -Last Operated or Above Threshold:
County:
Phone No:
Phone No: ....
1;1Integrator:
Operator Certdicatiorr Number•
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 " Longitude • d 14
Des r
Current
Cnrre�t Desrgrr Carreat
Swine;Po
. . Po onp P
Wean to Feeder
Layer
Dairy
- Feeder to Finish
3 Non -Layer
ENon-Dairy
Farrow to Wean
d
- ;
Farrow to Feeder
/thy
Llwl
� v
�
Farrow to Finish
-
T4#81 1)esj1n 3'
Boars
k " _ = Totat`SSLV
Nrtmber ail Lagoons �
f
�
��
JR
!cam
Disd arees 8 Stream RICts
1. Is any discharge observed from any part of the operation?
❑ Yes or&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 ,pNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes .13 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes `8'90
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ---
Freeboard (inches):
.12112103 Continued

Facility Number.,3 — 'X 2 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ 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?
S. Does any part of the waste management system other than waste structures require maintenanceirimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
••4�� s
jr k
❑ Yes Erfio
❑ Yes ,B'No
❑ Yes ;]-PQo
❑ Yes [Wo
❑ Yes O'So
❑ Yes ,Rrf4o
❑ Yes )] No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes.. Mo
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes'0'&o
❑ Yes J:;-No
❑ Yes _gKo
❑ Yes 'PNo
❑ Yes JlNo
❑ Yes ,;'No
❑ Yes .0'�To
❑ Yes EJ'No
,Use drams of fac�ty3tQjbetter er�ans>taatz�. {u�e!add;tmitsl€pages as ❑Feld Copy ❑Final Notes
rr rdFleldOS C,(e _ r
Y _CJ 01&1 y
fu
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date: 7
I2112103 6ndiiued

Facility Number: , — a Date of Inspection
Re4viied�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?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes .E'No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo
❑ 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 "ONO
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;$'Ro
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 2V0
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Jallo
28. Does facility require a follow-up visit by same agency? ❑ Yes QiQo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes , fNo
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ea Yes ❑ No
31. 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 .,Q No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes allo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes 12No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes _ 3to
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112/03

Date or Visit: � Time: T/�
Facility Number ?u
Not Operational 9 Below Threshold
6PermittedCertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
p / f
Farm Name: i1//j��� �ee_ County:
Owner Name: _ _aY /1� _ PSG �� g Phone No:
Mailing Address:
Facility Contact: Title: f��Phone No:
lh� Onsite Representative: l_ Integrator: 2& 1
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude �0 '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes A_x No
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 _E1 No
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? ❑ Spillway ❑ Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
—7YI
Freeboard (inches):
05103101 Continued

Facility Number: — %Z% 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 part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over apJplication? ❑/JExcessi/ve Ponding l ❑ PAN ❑` Hydraulic Overload
12. Crop type i1t u r �I !J�✓1hZ�01� �it!t�Z[l 7�1 /� eG iir Drl ASP57
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
1$. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes oNo
❑ Yes 8No
❑ Yes 21 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes H No
❑ Yes ❑ No
❑ Yes C5No
❑ Yes [SNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ®.No
❑ Yes R No
❑ Yes CKNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
V-No
P[No
Lr,",INo
[RNo
No
® No
® No
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Caminents'(refer #o.questeon # Eaplam4nv YES answers and/or apt. recommendattorts or=any;dther c menu
Ilse drawtn s of facih to bef#er eg "lam 1til"onS se additional i' es as=necessa
S p ( p. g �) ❑Field Copy ❑ Final Notes
,. g
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: P DZ
05103101 Continued

Facility Number: — z? Date of Inspection Z 7 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 91 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 C9 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 23�1Vo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes EJ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes IN No
5100

4-
i D1vlSlon a� WalGw
�'�==�i"' ��- QIhhvisian of Soil atud_Water Ca�gservatina ,G � �. �� i
�r-
.¢r 1/
1L:0n
visit Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: /5/ Time:
Q Not Operational Q Below Threshold
Permitted ©4dpj
Certified OUC�o^nditionally Certif'eed 13 Registered Date Last Operated orAboveThreshold:
Farm Name: » —.zr/,r.... N �-, ....... ............... County:..........tiL 4,/.pi—
Owner Name:...., .....1. a........./!C.�o.... 1 ......................................... Phone No: .............. ...............
FacilityContact: .....................:........................................................ Title:................................................................ Phone No:............................... .. ....._
Mailing Address: ---- ..............................
Onsite Representative:..,.... t � ......... Integrator: ... A.K,tQ?!ff!7`.:7 ............................................
Certified Operator:....................................................... Operator Certification Number:
Location of Farm:
Rf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 66 Longitude • 6
Design,:: ... Current ._ , . Design Current; _.. Desegetk Carraut
Swine Capacit4y Po elation h .Cattle Ca Po elation ,.
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder ❑ Other t
Farrow to Finish TotahDesign Capacity
Gilts -
Boars TUtal SSLW-
Number'of Lagoons
j_Holdmg Ponds /Solid°Traps.
❑ ❑Lagoon Area . I0 Spray Field Area
Subsurface Drains �nt
❑ No Liauid Waste Manaeement Svstem
DischaEges & Stream Impacks
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 of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3- Structure 4 Structure 5
Identifier:............�....j................................................................. ........
Freeboard (inches):
5/00
❑ Yes ,6No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes R�No
❑ Yes RTNo
❑ Yes )2(No
Structure 6
Continued on back

4. 4
. Facility Number: — Date of Inspection Printed on: 7/21/2000 ,_/�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Cl Yes �Vo
(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 part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Allplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? _ ❑
12. Crop type
Ponding ❑ PAN ❑ Hydraulic Overload
13. Do the receiving crops differ with those designated•in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
I7. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: �'Vo yiiilaiions or diMeWhi-ibs mere hbted- during this:visit: Yoit will-feeeiye iio further
�orrespondei ke. abi Uf this visit.
Comments (refer to'gnestron #) E_ platy any YES answers and/or at►y recommendattoits or any other eomme s
Use dra�vnlg;ol f chjity i better explain iitaatic use acldibo" pagesaas neces92`17)
l % AkF— D AFPDlef- FO/1 2�w%.
2,000
J.
❑ Yes J No
❑ Yes J3`N0
❑ Yes ONO
❑ Yes rr-N'o
o
El Yes
❑ Yes 9No
❑ Yes / "No
El Yes No
❑ Yes No
❑ Yes Q No
❑ Yes No
❑ Yes No
❑ Yes FNo
❑ Yes �6
❑ Yes No
❑ Yes No
❑ Yes [I
❑ Yes JZNo
❑ Yes No
❑ Yes ( No
A.
Reviewer/Inspector Name 1
Reviewer/inspector Signature: ®— � �� Date 1711411,P % 5/00
I

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes o
liquid level of lagoon or storage pond with no agitation? -/
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
I-Additional'Comments and/or rawings:
+1
5100

r K.
torsion of Water Quality
Y^ k
0 fS z
vtston o ail
Dt and Water: onservatton':'
x u f Q they Agency7.
O -
K.
�
Type of Visit Xcompliance Inspection ()Operation Review O Lagoon Evaluation
IiReason for Visit ^Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
t)ateof Visit: O 2El /OCR 'Time: i3 00
Facility Number Printed on: 7/21/2000
3 [ Z,
Q Not Operational 0 Below Threshold
/XPermitted [3 Certified 13 Conditionally Certified C] Registered Date Last Operated or Above Threshold: ...................
Farm Name: >� rt Lhi,............✓. t0'l. County:...... j�.ih..................2,0
...........�..
n...... eve......... r .....
Owner Name:....... .h. L i.....rZY►ai....k............................................ Phone Noly ...... !.. •..zS ..f.. 0 ..........
Facility Contact: J...T.... 'i �hi�.'title: Phone No: .......... .......................................
Mailing Address:....... . ..........'C .....................rYZ'7...�..
Onsite Representative.....`..... �-.......�. ri� � . S � Integrator:......----•..... h�.....................................
..................................... /, 1.....I...-.....
Certified Operator:.. ...............................................• ............................................................. Operator Certification Number:................................
Location "of Farm:
A
D(5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca aci Population Cattle ca.pacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish 3 ❑ Non -Layer JE1Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number or Lagoons JCI Subsurface Drains Present ❑ Lag -on Area ❑Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Irnpacr
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) ❑ Yes ❑ No
c. II' dischar«e is observed. what is the estimated now in gal/rain"!
d. Does discharge bypass a lagoon system? (If yes, notify D�4Q) Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes dyNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Sn•uLAre I Structurc 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ........... ew
.....................
Freeboard (inches):
5100 Continued on back

Facility Number:; —1Z Date of lgspection ( /o+C} Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes
(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 part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type HVLJ Der6wd ri 4%/ t ,�11c" C_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: io'yiolatigtis;oe deficiencies were pgted-during �his:visit: • Y:oi} will-i-eceiye Rio further
;correspondence: abou>� 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):
16
❑ Yes *o
❑ Yes XNO
❑ Yes eqo
❑ Yes KNo
❑ Yes WNo
❑ Yes gNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,�rNo
❑ Yes NrNo
❑ Yes >V10
❑ Yes XNo
❑ Yes 0
❑ Yes XNo
❑ Yes ONO
❑ Yes XNo
❑ Yes WO
❑ Yes )ZrNo
❑ Yes lkfNo
Reviewer/Inspector Name
T� ss tC
Reviewer/InspectorSignature: — VC, grA1 Date: 5100

Facility Number: —12. Date of luspection t7 Z Printed on: 7/21/2000
*' Odor Issues
26. 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? //``
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;(No
roads, building structure, and/or public property) /�
29. Is the land application spray system intake not located near the liquid surface of the Iagoon? ❑ Yes X10
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 �To
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes TO
32. Do the flush tanks lack a submerged fill pipe or a pei-manent/temporary cover? ❑ YesXNo
'AddifionaFCommentsand/or Drawings:
5100

O:Division of Sod and Water- Conser6ahon Operation Review
- _J�.,Djlivis
ision of Sod and.�Vater :Conservafaon _Comphance Inspection `
-ion.of Water Quahty ;Compliance lliuspettion
Other Agency Operad6n Review �
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted 13 Certified Q Conditionally Certified © Registered JE3 Not Operational Date Last Operated
FarmName .1County :......- �k............................... .......... ............
c
Owner Name: ••••••.•••. Phone No:
Facility Contact:.............................................................................. Title:....
MailingAddress:.........................................................................
Onsite Representative:... W,h2- .............................
Certified Operator:....................................................................
Location of Farm:
....................... Phone No:..........
. ..........................
Integrator: ....................Y.................
...............................
Operator Certification Number:,,.,,••••.•,••••,.,
J
..................................................................................................................................................................................................................................'...................................-.. 1
Latitude • 6 i Longitude ' ° ig
Design Current; _ __ Design Current= ...._ ' Design Current
5wtne - Ca" acity Population ... Poult . _
::. -
17 .-=Ci bacity-- Population Cattle .Capacity Po ulation .,„
❑ Wean to Feeder JE1 Layer ❑ Dairy
"Weeder to Finish ❑Non -Layer . ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total D6iP_n-CapaClty `
❑ i
Gaits
❑Boars - = TotalasLw
Number ofLagoons . ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
4>
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagooii ❑ 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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes 1 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Mo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............ ..................................................................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes X No
Continued on back
3123/99

Facility Number: 3 — �9 #)ate o#'Inspection
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 part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
You wiil reeeiye Rio' further
. • Torres- oncYenee. abaut this visit_ .... ...
Comments {refer to question #):Explarn.any YES answers and/or aity recommendattons;araay otherpeomments
- � v
Use draivin of fac>It tii Better-explatn:sttuations (use additional -pages as.necessary} �dm
:_..._. � n
"A
5 -V,
❑ Yes XNo
❑ Yes 0 No
❑ Yes )<No
❑ Yes `;jrNo
❑ Yes X No
❑ Yes 9No
❑ Yes )RI No
❑ Yes X No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ONO
Cl Yes 10 No
❑ Yes JIM No
❑ Yes XNo
❑ Yes A No
❑ Yes ONO
❑ Yes bd No
[]Yes ;XNo
❑ Yes gNo
❑ Yes [(No
❑ Yes -4No
Reviewer/InspectorName
Reviewer/Inspector Signature: Date: I 11 ir? � —
3/23/99

Facility Number: — a Date of 111spection
Odor Issues
•26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ((No
roads, building structure, and/or public property) \`
29. 1s the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
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 [KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �] No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Additional -Comments an or ravings_ _ _..:. - _
3/23199

Lagoon Dike Inspection Report
75
Name of Farm/Facility Z r� _ 7 �'!� t
Location of Farm/Facility tjCA,
Owner's Name_ Address Art �n ruin i14L
and Telephone Number
Date of Inspection
9 - 2-9- 9 1
Names of Inspectors
A19)[7
Structural Height, Feet
1� � "!.
Freeboard, P�eF
ii
I�
Lagoon Surface Area, Acres
�•S ���"��
Top Width, Feet
Upstream Slope,xH:1V
3-
Downstream Slope, xH:1V 3 - r
Embankment Sliding?
Yes to".�No
(Check One, Describe if Yes)
Seepage? Yes _�o
(Check One, Describe if Yes)
Erosion? Yes �-'No
(Check One, Describe if Yes)
Condition of G !q nas Vim-!! 1L-P71 [xcn GSM f! a t
Vegetative Cover
(Grass, Trees) iL7J
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes l/ No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes < o
Other Comments al r. &yI � h LAA enowa� 4'14-i ��

M❑ Division of Soil and Water `Conservation ❑ Other Agency ,
Division of Water Quality
O Routine O Comnlaint O Follow-uu of DWO inspection O Follow-up of DSWC review O Other
Facility Number
Registered 10 Certified © Applied for Permit © Permitted
Date of Inspection
Time of Inspection L 19 -S 24 hr. (hh:mm)
l�
13 Not Operational n Date Last Operated: •,•,•••„••••••-
Farm Name:....................N�r ..LC.r....... JL414. 6Xk..-Mtn.r..&................................. County:......iljjp.(at,...................................... .......................
A"
Owner Name :....... ...... t Sr..1n ....t..... ................................ Phone No:..... C.I.IaL?:.��`.t.......................................
Facility Contact: ............................fl....iS- Title. CPhone No: ...................................................
ir��yt ," rtAC. } L1
,� t c
Mailing Address: ........ .... A-.....Ox...�A.[.f..t--�........................................... 2$q&6 ...........
Onsite Representative:........... C. ..... +1q�+.S1 .................. .... Integrator:......."-..
Certified Operator:............................................................................................................... Operator Certification Number ;.........................................
Location of Farm:
a1P! ........... f.....-------------•.................-•----•---............................................ �
Latitude « Longitude
`a llesxgn Current _ Design Current' Design ° a Currexxt
5wine 'F x Capacity Papulatton,': :Poultry Capacity,: Population Cattle Capacity Population f
❑ Wean to Feeder
® Feeder to Finish
3G-j Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer 10 Dairy
❑ Non -Layer I0 Non -Dairy
❑ Other
'''� �� • � Tool Deslgn Capac,y C
Total SSLW
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ^A No
2. Is any discharge observed from any part of the operation? ❑ Yes 1M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [3 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [n 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
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
(3 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system•(other than lagoons/holding ponds) require
❑ Yes
b No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes]
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[ No
7/25/97

facility Number: 11 — 12'1
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[9 No
Structures (LagoonsMolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):.............3..x:............................................ ....................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ 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
IR No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
JO No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type . ...............,..................M A. �1.h.........................................................................................................
.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
I] No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes]
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement?
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?
❑ Yes
O No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P3 No
25. Were any.additional problems noted which cause noncompliance of the Permit?
❑ Yes]
No
[� No_vio'lationsor' ddiciehdeis e.re-noted during this'visit.• Yoil.'W } recei've,iro further
correspondence about this'. visit.
IZ. C.6r,�Aquf_' t {'-orls �o Vt�e
11. &_V-Mu(6 i m small �ItaS
zz. s tt6l y-c,oA%, S*tov1J 6e.
AK
v�� e eti.o �u►�c pS-
t�k. O? V.- WO-11.
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{ by ��I�) USsn)'� Corree'� ln.(,V��")ke4... CC,EGv1�{ j
Orec,��,iII
7/25/97
'Reviewer/Inspector Name
tReviewer/Inspector Signature: �, Date:

Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSNVC review O Other
Date of Inspection 1
Facility Number 3 Z
Time of Inspection 3=00 j 24 hr. (hh:mm)
Total Time (in fraction of hours �
Farm Status- ❑ Registered ❑ Applied for Permit (ex:1.25 for i hr 15 min)) Spent on Review
IN Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ... .. .__.... �.._ .. .._. _ ......_._...._ _.... �_ .. _ ._r ....�.... _...
Farm Name: .. ?�1rxS� ...iL.. ter...__................_....__.._ ... _......... County:-_�_.......
_ ...._...
Land Owner Name: i _ ��5.�._.. _ .... ..... �......_..... _._..... ___ Phone No: ........ ..._....
Facility Contact:..._ �t...�� ...._............. _.... _... Title: lu.f............. _...._. Phone No:..��Q��. .......
Mailingg .....
Address:. . �pRS. ems.. :....._ ._... ... ..............._. �ICL.� . L .. z.. _ ......... ...
Onsite Representative:..- ` �� ��...G�,�L� � �i � _ � ... Integrator:
Certified Operator:. %. ._... .. Operator Certification Number:
Location of Farm:
►a� .:. _... L . i�A
Latitude �• �° u Longitude 1 % • S o
Type of Operation and Design Capacity
.: Currentl)ecign Current
Swine Ca aci pCurreho poultry Ca aci Po uiahon Cattle WrEbRCKVPo` 61266n
❑ Wean to Feeder ❑ La ' ❑ Dairy
Feeder to Finish 3 L ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean 7
Farrow to Feeder Total Design Capac[y 3 x
F
Farrow to Finish
x
❑� T al SS of LW o
Number of Lagoons f Halding Ponds ❑ Subsurface Drains Present
R.
❑ Lago ❑ 5 on Area pray Field Area
General
I. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
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
4/30/97 maintenance/improvement?
® Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes
CR No .
❑ Yes
19 No
❑ Yes
No
❑ Yes
® No
Continued
on back

Facility Number:...-�..... —.-7..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ,A No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (I,a;oons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
. _ Z ...... ....... .— ._ ...._
10. Is seepage observed from any of the structures?
Structure 4
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 APplicatiog
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _....... .COSS-kL..... 6mW................................................................
❑ Yes ® No
❑ Yes 19 No
❑ Yes f9 No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
I7. 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?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ® No
❑ Yes ®No
® Yes ❑ No
❑ Yes R No
❑ Yes 9 No
❑ Yes (9-No
❑ Yes [% No
❑ Yes 09 No
❑ Yes O No
❑ Yes R1 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes 19 No
❑ Yes R No
Continents (rcfer to question #) Explain aiiy YES'answers andlor any recommendations or any, other comments
Use;drawmgs of facility to better explain situations. {use addihonal pages -as necessary)
M
. ,
pp1�� r 1y 1
I �s i tr _ ih" ei he cS relbl l5�u0 � loYtq 1� Y�oo�r i0� Ag f j u .
Q
iz- T,Ves n. houses s u�a be ex dc� tr' 'JO JAL awn. Mtper Qro%ion axzAS
Reviewer/Inspector Name '_�
Reviewer/Inspector Signature: Xj Date: V/ 1 % 7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

0-
Site Requires Immediate Attention: /vim
Facility No. — L
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
DATE: — , 1995
Time: /lip
Farm Name/Owner:
Mailing Address:
dAW
County: Z)Zle '
Integrator: �(Ji7Phone:
On Site Representative: ! IL Qi Phone:
Physical Address/Location: % _ffO r /.
Type of Operation: Swine Poultry Cattle
Design Capacity: 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 have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inche Yes r No Actual Freeboard:Z Ft. Inches
. Was any seepage observed from the lagoon(s)? Yes No as any erosion observed? Yes r No
Is adequate land available for?sray?/J Yes or No Is e cover crop adequate? Yes or No
Crop(s) being utilized: 23 1�1�!'�'� i� �i % /� �' • �S fJ q,*
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es 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 r No f%
Additional Comments: % Z ' /�l ��_ ��' _ �N lV @A�, weed! L-
• �W12L11�'jYtf�
Inspector Name
cc: Facility Assessment Unit . Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: g S _, 1995
Time: I
Farm Name/Owner: yes C l�ecec5ec,` Cr
Mailing Address:
County: - XX) _vtn
Integrator: _ 1'� oTe�N �3 -__ Phone:
On Site Representative: _ _ Phone:
Physical Address/Location: CS R I �!)c7 i . S F
FT C
Type of Operation: Swine Poultry Cattle
Design Capacity: ^' J Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 7' I" Longitude: 7 7 S o ' 3 �9 Elevation:- 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) Yes or No Actual Freeboard: -,?--Ft_ Inches
. Was any seepage observed from the lagoon(s)? Yes o o Was any erosion observed? Yes or(No, j
Is adequate land available for spray? Yes or No Is th cover crop adequate? Yes or No �/
Crop(s) being utilized: • C,04'�S 7AL_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes° or No N+ n4 r3c Ba-NC
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 S
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)? 1Y s or o
Additior Comments: J k�,., w
tjrJ�i—
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

OPEPRT_ONS BRRNCH - WQ Fax:[phone] Jul 20 '95 12:58 P.09109
SiTc Requires immediate Attention
• Facility Number: Z
.7
SITE VISITATION RECORD
DATE: 7 t ,1995
Owner: C 5SC, Grr�t Farm dame: a m G
County:
Agent Visiting Site: —tea J 4-a, - Phone: q 1 o. -.7 2 a
Operator. I
Phone:
On Site Representative: Phone:
Physical Address' aA ® Ltv a J Ocrn
Mailing Address: --
Type of Operation: Swine -,-• Poultry Cattle
Design Capacity: _:361? Z Number of Animals on Site: 391) Z--
Latitude: o " Longitude: a
Type of Jnspection: Ground X_ Aerial
Circle Yes or No
I
Does the Animal Waste Lagoon have sufficient eeboard of I Foot + 25 year 24 hour storm event
(approximately IFoot + 7 inches) Yes o N Actual Freeboard: --L- Feet -- Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erasion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes of No
Additional Comments:
Fax ro [phone] Signature of Agent