310159_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: U7olutine
ce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: O Complaint O Follow-up Q Referral O Emergency Q Other O Denied Access
rM /Date of Visit: 2 Arrival Time: Departure Time: County;
Farm Name: �ji%� !.� �> Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Region: IV) II
Integrator: Y;� Za 1
Certification Number:
Certification Number:
Longitude:
Design Cnrrent
Swine Capacity Pop. Wet Poultry
Design Current
C►►opacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
I
jNon-Layer
I
Calf
Feeder to Finish
Farrow to Wean
1) , Ploultr,
Design Current
Ca a_ci P,o
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other _ __ _
Turkeys
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes to ❑ NA ❑ NE
[:]Yes io
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
2
❑ NA
❑ NE
[] Yes
E10"I
❑ NA
❑ NE
[—]Yes
[
❑ NA
❑ NE
Page I of 3
21412015 Continued

Facili Number: - j Date of inspection: 1 /i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes <o ❑ 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): i
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 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
E;�<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[?No
❑ NA
0 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
2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'Flo
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2 'moo
❑ 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
&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ l�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ea'<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[<Io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F-;KO
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�!rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EK0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection: / Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ONE
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? 0 Yes ' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2 o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EJONo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
[j]No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[? No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ca<
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FReo
❑ NA ❑ NE
Comments (refer to question #):, Explain any YES:.answers and/or any additional recommendations or, any other comments.:.
Use drawings :of facility to_Iieiter explain situations. (use additional pages as necessary)
.
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 214/2015

Type of Visit: 9.C'ompliance 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 0 Denied Access
Date of Visit: � Arrival Time: p ; o � Departure Time: O County: ,,.� Region:
Farm Name: -&r, Owner Email:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: r-.-,�� -
Certification Number:
Certification Number:
Longitude:
Design Current
Design Current Design Current
Swine Capacity Pop,
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Di, P■oul C•_a a_ci_ P.o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Turke s
Other
Turkey Poults
Other F70ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes ,�No
❑ Yes Pj'No
❑ Yes L2 No
[:]Yes ZNo
[:]Yes F2/No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CyNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [2rNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: Z,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_ 2�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes JZNo ❑ 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 J?5No ❑ 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 L?l"No 0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 5 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 EfNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 7No [DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
/
[] Yes 0❑ 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 Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P-�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—]Yes
f"No
❑ NA
❑ NE
❑ Yes
P�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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 PrNo ❑ 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 ;�f"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:227,72/
24. Did the -facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,?'No ❑ NA ❑ NE
25.�Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�JNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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:
❑ Yes �' o
❑ Yes ;No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes r,}No ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Vf No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ NA ❑ NE
Comments {refer to question #)::Explain':any;YES answers and/or any additionalrecommendati©ns or any other. comments;
Use drawings of facility to better explain situations (use additional pages as necessary). -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tr-A
Phone:
Date: 12-J-21 J/
21412015

►/
Type of Visit: I2'0ompliance Inspection 0 Operation Review Q Structure Evaluation () Technical Assistance
Reason for Visit: Q<outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit:W Arrival Time: I /4 , 3 (::-,kt9eparture Time: County: Region:
Farm Name/U Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: T.
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
Layer I I Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
M1
INon-Layer I
I Dairy Calf
—Dairy
Design C►urrent
D , P,oulti, Ca aei P,o ,
Layers
Heifer
D Cow
Non -Daily
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
Other
Other
IRL
Discharees 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 DWQ)
❑ Yes _E No ❑ NA ❑ NE
❑ Yes �ffNo ❑ NA ❑ NE
❑ Yes ;31No ❑ 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) ❑ Yes OlNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

Facili 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 J2'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6 %% -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 12'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 P11No ❑ 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 _13'% ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F,,�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 �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application VNo
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑'No DNA ❑ 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 4�fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes J2]rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 'E2'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?
❑ Yes -ETNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ]2]�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _12-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 JED"Ro ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O/No ❑ NA [] NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: 5`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PNNo ❑ 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�r`No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C}'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes RNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes P No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ,allo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes 2rNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes O No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ;;] No
❑ NA ❑ NE
Comments (refer to question.#): Explain any YES answers and/or any additional recommendations or'any other comments: '
Use drawings of facility to better explain situations (die additional-nages as necessai-A }'
Reviewer/Inspector Name:
Reviewer/inspector Signature: Af—I
Page 3 of 3
Phone: //6a
Date: ` l
21412014

r-)
Type of Visit: iO Co ance Inspection CU Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: c arrival Time: s "arture Time: County: 2 �///-lRcgion:
Farm Name: �Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: `' rrr—
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pop.
Design
Cattle Capacity
Dairy Cow
C*urrent
Pop.
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D<< P.ouI
Layers
Design Current
Ca achy P,o ,
airy Heifer
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ''No ❑ NA ❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
4!fNo
❑ NA
❑ NE
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 JZ No
❑ Yes ,2frNNo
❑ Yes I XNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Eacili Number: - jDate of Ins ection:
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 ONo
❑ 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 o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes [-No
[DNA
❑ NE
waste management or closure plan?
7
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 No
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,.setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement? .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes gNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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?
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'JINo
❑ Yes E�No
❑ Yes P<14o
❑ Yes �' o
❑ Yes allo
❑ Yes 'I No
❑ Yes JE2'No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EnNo ❑ 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 ❑ o NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes�'No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: 131- Date of Inspection: f r
24. Did the facility,fail to calibrate waste application equipment as required by the permit? ❑ Yes )2jrNo ❑ NA ❑ NE
25. 1; thelacility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r-31No ❑ 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 j2 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 the 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 ;2-No ❑ NA ❑ NE
❑ Yes ):�rNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes /No
❑ Yes No
❑ Yes <o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Ca
Reviewer/Inspector Signature: Date: ?__r! A3
Page 3 of 3 21412011

Faciilty�Number`-
Er
�btvtstan of VV,ater Quahts .
0. Division of Soil andrvWater'ConservaEtan
Type of Visit _*0 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: Arrival Time: Departure Time: FVA 67 1 County: AOL—Region: G `�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Phvsical Address:
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 = 6 0 Longitude: = ° = 1 a
Design Current �„ err, Design Current Design Current
.0;5
Srvme" � .Ca act Pa" Mahon '�Wet�Pdultry" Ca aci �Po Mahon; "``Cattle Ca aci P.a ulation
p- mot?, t� p:- , � . F r d �P� gtY�, r..P ._. e P �3 P
IER]Non-Layeir
La er
El Dairy
Dry 0,
El
ElLayers
ElNon-Layers
El Pullets El
�, .», .: ❑ Turkeys
El Turkey Poults
❑Other ❑Other Number ofStructures.
El Wean
El Boars
❑Wean to Finish
❑Feeder to Finish
❑Farrow to Wean
❑Farrow to Feeder
El Farrow to Finish
❑Gilts
to Feeder
Calf
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El 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 ,LxNO ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes -EfNo
❑ Yes Fe No
❑ NA
❑ NE
❑ Yes ;2rNo
❑ NA
❑ NE
' 12/28/04
Continued

Facili Number: - �CS7 Date of Inspection. -
Waste Collection & Treatment
4. GIs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,EfNo ❑ NA ❑ NE
y 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 W"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 No ❑ NA ❑ NE
waste management or closure plan? rr��
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 ETo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) +T
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 V(No ❑ NA ❑ NE
maintenance or improvement? /
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes PNo ❑ 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 eNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0', ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ,EJ No ❑ NA ❑ NE
❑ Yes ry o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes PrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �o
❑ 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 effNo
❑ 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 �No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes dNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - G �7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PNo
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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:
❑ Yes jNo
❑ Yes 01No
❑ Yes eNo
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes -[Y(No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes &I ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any. additional recommendations or -any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
i.0i
1� 7 e6 z--
3191it 3,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:w� < <(9 " / Ze
Date: 7 G2% l
V412 I

Type of Visit 'Q_�Ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit _Q�-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /A"7' Arrival Time: �i Departure Time: County: Region:
Farm Name: �`� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: , LAOS t 4'1&40� V-"
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: / )11
Operator Certi ication Number:/// � (O 6
Back-up Certification Number:
Latitude: = o = = 4i Longitude: = ° = 6
Design Current Design Current Design Current
Swine
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to finish
❑ Layer
I
❑Dairy Cow
❑ Wean to Feeder
❑ Non -La er
I
I
airy Calf
❑ Feeder to Finish
❑Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Non -Layers
❑ Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
❑Turke PouIts
100ther
Other
Number of Structures:
❑ OtherI
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 I of 3
❑ Yes Plo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ,ONo
❑ Yes
RfNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. 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 ❑ No ❑ 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 ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? -
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
4,
�,d. 5
p
oon Jeve
r e
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0 %O d Departure Time: County:
Farm Name: >s�rd / OG 2— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 7�+ t°
Certified Operator:
Back-up Operator:
Phone:
VRegion!±°&
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I = Longitude: = c = 6 =
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Papulation
C►attle Capacity
Population
❑ Wean to Finish
JE]Layer
❑Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
❑ Turkeys Pullets
❑
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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)
❑ Yes
0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
S!rNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9;No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility 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 dNo ❑ NA ❑ NE
5 ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed freeboard (in):
Observed Freeboard (in):
5. Are there any immediate th eats to the integrity of any of the structures observed? ❑ Yes ,I"N^o
❑ 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? El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ElYes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Io
ElNA ElNE
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o
❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) !!l111
❑ PAN ❑ PAN > 10% or 10 Ibs [:]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? ❑ YeZNo
No El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Ye ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes CK9 ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes .VNo
❑ NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ NA ❑ NE
- r-O f M q- 6-e, c- 0 r
S /pQ)r-- J5000%` C
S
r �
Reviewer/Inspector Name e Phone: Q
Reviewer/Inspector Signature: Date: ZZ
Page 2 of 3 12128104 Continued

FacilityNumber: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �fNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps [I Other
21.
Does record keeping need improvement? 1f 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 1" Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYesX!
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
XT
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
X
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes RfNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes I�Ko ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 'P'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 ;Z'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 940 ❑ 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 V� o ElNA ElNE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
AddltionalComents and/©rDiawmps» *
b
Page 3 of 3 12128104

a
Division of Water Quality
[Facility Number. 3 f /�j 0 Division of Soil and Water Conservation
-- 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit fib Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,r/� Departure Time: ��County: 41_xd Region: wr s�0
Farm Name: y8q,90h Z 4Z Owner Email:
J
Owner Name: r �n�GF_c/-C,(}SS Phone:
Mailing Address:
Physical Address:
Facility Contact: !. Title:
Onsite Representative: ✓l%� ynirk/ �tgmGS
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑_Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
r1B
row to Finish
tsars
Other
1-1 n+tie.
y� Phone No:
Integrator• B
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry. Capacity Population
i ❑ La er
�' ❑ Non -Layer
3
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
FP Pouets
—Turkey
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: FZI
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 Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
❑ Yes'.,JKNo
❑ NA ❑ NE
12128104 Continued

Facility Number:/
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Structure 2 Structure 3 Structure 4
Identifier: iel
$11
Spillway?:
O
/A�o
Designed Freeboard (in): /7 •51�
Observed Freeboard (in): 2 Z
�Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4fi 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 IVNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z 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 ;eNo [INA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes A No ❑ NA
❑ NE
maintenance/improvement?
]1.
is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes J0 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 Wind Drift ❑ Application Outside of Area
12.
�� rrof
Crop type(s) CiiQ (NL�ZFL !� �(T, !O✓`.xLf�
13.
Soil type(s) Av`A 14AIA j44,,8 LN�7
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 9No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes A, No ❑ NA
El NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes )6No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):,
pv�c
Reviewer/inspector Name f Phone: (ij 7i l
Reviewer/lnspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number:. — Date of Inspection
Required Records & Documents
19. 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 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [3 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �INo ❑ 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
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ 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
�No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
If
I
Page 3 of 3 12128104

Type of Visit ^ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: cn Arrival Time: ld•'3 Departure Time: County: 4e /
Farm Name: �fiyo �C/ rfZ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: CC `` Title: Phone No:
?
Onsite Representative: ;n c J a nN &.5 Integrator:
Certified Operator: Operator Certificatio f umber:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: = 0 0 6 =,A Longitude: = o= 6 0«
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer I
❑ Non -La es
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
i
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [,_�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,_❑..,,��No ❑ NA ❑ NE
El Yes L7 NNo ❑ NA ❑ NE
❑ Yes LJ No ❑ NA [:]'NE
12128104 Continued

Facility Number: 3 — Date of Inspection /L o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,0No ❑ 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: ! _ 2—
Spillway?: p _
Designed Freeboard (in): / • S �� S
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ji No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ YesXNo ❑ 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 �o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )�I`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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Pio ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of in application? If yes, check the appropriate box below. ❑ Yes E:I'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 -.ETrlo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes -El—No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes ffN`a
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes —E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _LJKo
❑ NA
❑ NE
refer to questtvn #) Ekplain any YES answers and/or any recommendatiions or any`
Reviewer/Inspector Name
Phone: `f�(%- ZYC _ 72G
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 3
jl Date of Inspection 1 O
Required Records & Documents
19. 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 J2,No ❑ 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 �JNo ❑ 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 -2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes J2'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 2No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes J2'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �3 No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes B'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes E�'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 ,;3No
❑ 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
�
Elf Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes LiI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
1,7
12128104

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ZORoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number { Date of Visit: ' G ` Time:
Not Operational O Below Threshold
13 Permitted © Certified Q Conditionally Certified [3 Registered Date Last Opera or Above Threshold:
Farm Name: LC r .�>~ �� .?2�= . county:
Owner Name:
- Mading Address:
Facility Contact: ..... __. _ _ _._.. Title:
Onsite Representative: Zed � .
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator. _1/A�a20��
_..... _
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • ' " Longitude • '
DesigP
ry
:Cm r ea =Desurgn
_
'x Cnrreo - Desiga
' Cur reat
Swine - _ - -
Po on p
on DIM
Po iron
.
_
Dairy'�
Non -Dairy
D'Signi(('�������}�
�'a!'a`'`� s
.41 f
El
''4
s�
... ..:RID
I
- wean to Feeder
Layer
er to Fmish
�
Non -Layer
Farrow to Wean
1-p
�r
��_
Farrow to Feeder
Farrow to Finish
r TD�
'� � �� x• .
r � s
CTIltS
Boars
�-
Discharges & Streams Im acts
1. Is any discharge observed from any part of the operation? ❑ YeseQ'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 �}No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ErNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes -Ergo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _11.--------- - _ . `
Freeboard (inches): '30
12112103 Continued

Facility Number: — -< Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
1_0-NO
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
closure plan?
(lf any of questions 4-6 was answered yes, and the situation poses an
_Q-Ko
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 12-No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes .0"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes -j�'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement?
❑ Yes _2No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN [I Hydraulic Qverload ❑ Frozen Ground ❑ Copper d/or Zinc
Crop type
13. Do the receiving crops differ with those de ignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes -ENO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ETRO
b) Does the facility need a wettable acre determination?
❑ Yes -0-No
c) This facility is pended for a wettable acre determination?
❑ Yes .0No
15. Does the receiving crop need improvement?
❑ Yes �To
16. Is there a lack of adequate waste application equipment?
❑ Yes 9.110
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes J2-No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes O'No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes O'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes Flo
Air Quality representative immediately.
ReviewerAnspector Name Q
ReviewerAkspector Signature:
Feld Copy ❑ Final Notes
-SAeya? iL
Date:
lLJlL/1IJ 1.07:WSFL�[i

Facility Number: _ sti Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes O- No
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 U-No
23. Does record keeping need improvement? If yes, check the appropriate box below. .Yes ❑ No
❑ Waste Application [Freeboard ❑ Waste Analysis ❑ Soil Sampling
i
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes .Ej No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes _�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
ONO
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
ZNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
P No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P.1Go
LAMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
j'Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,E 'No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
33. Did the facility fail to conduct an annual sludge survey?
.,[Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
Q�No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
ETYes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall 0 nbspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
3 s� p/ec-eye_
12112103

Type of Visit M Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Q Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
rO Not 0perational 0 Below Threshold
® Permitted M Cee�rtMed 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold -
Farm Name: &P D k -0 / d - County:
Owner Name: Phone No:
T"
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm -
Phone No:
Integrator: _ AU121 v
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 04 UK Longitude 00 6
Design
Current Design Curreut Design
Current
wine Ca aci
P,o elation Poultry Ga aci Ea ulatlon Cattle Ca aci
P,o elation
❑ Wean to Feeder
Layer ❑ Dairy I
FoNon-Layer
® Feeder to Finish
❑ Non -Dairy I
Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
11111IIE"I
Gilts
Boars
Total SSLW
Number of Lagoons
0 ❑Subsurface Drains Present JJE3 Lagoon Area ❑ Spray Field Area
Aolding Ponds /Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Img Acts
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: / Z
Freeboard (inches):. 3
05103101
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes Ca No
Structure 6
Continued

vJiv.)ivl
Facility Number: 31 —
Date of Inspection l7 0
c.untinueu
S. 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 maintei►ance/improvement?
❑ Yes I}No
❑ Yes 9 No
❑ Yes [[No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [A No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [RNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [RNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [gNo
12. Crop type j6 fl ! 4&. � 647,) _ SmtJ1 �►'a 1 n Qutrg t td� _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JSNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes allo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes PLNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes X No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes @ No
19. Does record keeping need. improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes SNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 04 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes [RNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
24. Does facility require a follow-up visit by same agency? ❑ Yes Eallo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 5jNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commenis (refetquestion _ • xplaineany YES answers andlarany3recommendations oranyother comments -__
�s�e d w�g�o ffiac�ty:fog m er�exp asetua �ons.�(usea atwD�na pa ges as°necessary �,"
❑ Field Copy ❑ Finat Notes
�
i -I
Aie ' — Fe Ids 7 need6 Ljme. x4- /, I r d- /D necA �Jrte 4f 7,/4YMN / S :'C tSP.( 144wt4
i
4.h1[ Ji"I en j1v}fir4� if' Qvf i5 S✓�rtA!
krv, apt Vei'Aiyt /Tires llPt�iir144 On
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Facility Number: — 1511 Rate of Inspection 7 Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Drawing's:
❑ Yes 91 No
❑ Yes 29 No
❑ Yes R9 No
❑ Yes ES No
❑ Yes KNo
❑ Yes Z[No
❑ Yes S No
OSIO3101

Type of Visit (Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: I�.Y1 tTime: 3 d
O Not Operational 0 Below Threshold
Permitted [3 Certified 13 Conditionally Certified 0 Registered Date Last Operated or [hove Threshold: .� ...._....
Farm Name: ..RS ..... &:�............................... ..... County:..... ........................ .....
... ._....... .
OwnerName: ...... . ........................................... ..................... I ....... I .................................. Phone No:.................................................................. .... ... »....»» .
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
Mailing Address:.................._..........................................
Onsite Representative:... ..................... Integrator: .....
'r ............
__
Certified Operator:................................................................................................................ Operator Certification Number:.............................,. , ....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° « Longitude • 4 "
Design : Current Design Current Destgo - Cnrr�t
Svvtne
Capadty..Population , Poultry .. , Ca acity, Population Cattle = Ca aci ,Po '~ tlon.,
Wean to Feeder 10 Layer ❑ Dairy
eeder to Finish T13 ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present I[] Lagoon Area ❑Spray Field Area
Holding Pondsi Soud Traps`. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
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?
& 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 0,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ) No
Structure 1 Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Identifier. ................................................................. ......................................................................................................................................................
Freeboard (inches): �a qV
5/00 Continued on back

Facility Number: —Kj I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yei )ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes qNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JUNO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes tqNo
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
12. Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes )N�No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Xi4o
b) Does the facility need a wettable acre determination?
Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
NfYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
aN
Required Reco_rds_& Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
0 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
['No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
PKNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
,&No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes gNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 12No
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes gNo
No•yij at�idAs:or &rjejepcie�s mxgrp pot o 00.ing �hjs:vJjsit; Yop witl >�ec�iye po fu�th�t. .
coriis�o deuce: al)outi this :visit: - - '
(use
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: g/pp

Facility Number: "3 Date of Inspection/G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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 �No
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 ro
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
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Ye /s �1 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes A-Ko
5/00

Dtvis n of Water al ty _r
} T Q Division of Soil and Water Conservation
x
sY
Other`Agency
Type of Visit o Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number t)atc of VisiE:
Permitted [3 Certified © Conditionally Certified E3Registered
FarmName:....J...r�........................................-.-.................................-
- CJO Time: � Printed on: 7/21/2000
Q Not operational 0 Below Threshold
Date Last Operated or Above Threshold: .......................
County:.... 1\..... ...... ......... ..... I ----- I-- ... I —
OwnerName : ................................................... ............................................ ..-......................... Phone No: ................. -,................... .................................................
Facility Contact:-.................................................................... ....Title Phone No
Mailing Address: --.......—........................................... .
Onsite Representative:t^-y�Q,,, ••,,,!r c`;`'t ,,,,,, Integrator:t"�_
-•-•--•....................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..--.--..........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' C 1° Longitude 0 6 94
Design Current Design Current Design Current
Swine Capacity Po ulation Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
jgTe—eder to Finish JEJ Non -layer I I IQ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag,•^n Area JE1.5pray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance nian-rnade?
b- If discharge is observed. slid it reach Water of the State? (if yes, notify DWQ)
c. li' dischar2 c is observed. What is the estimated flow in gal/inin?
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
StrUCturc 1 Structure 2 Structure ; Structure 4 Structure 5
Identifier: .................................... ....................................
Freeboard (inches): Lt ri 3 d
5100
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes )qNo
❑ Yes X'No
Structure 6
Continued on back

Facility Number- —1 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
WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
kNo
(1f any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
)KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
KNo
elevation markings?
❑
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
I❑ No
]I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
Oyes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
jffNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
MNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WNo
(iel WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
J<No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑ Yes ONO
23_ Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes D;rNo
24. Does facility require a follow-up visit by same agency'? ❑ Yes jQfNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes h(No
W •yialatioris:oi- deficiencies were itgted- during 4his:visit'. • Y:ou will Teceiye iio further
,,......_.. ....
corre�ondeike about. this .visit_ L.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use. drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date: r �CQ_ 5100

Facility Number: —KC( Date of Inspection ' ' 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 itlor below
) Yes
❑ No -
liquid level of lagoon or storage pond with no agitation?
r
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�NO
28.
Is there any evidence of wind drift during Iand application? (i-e. residue on neighboring vegetation, asphalt,
❑ YesN0
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
j r-0
`` 16No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
5/00

Lagoon Dike Inspection Report
Name of FarniTaciiity
Location of FamJFacility 5,e /.q H&c�
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
Embankment SIiding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Yes `k No
Yes _�4__ No
Erosion? Yes _ [� No
(Check One, Describe if Yes)
Condition of
M've Cover
Trees) _
Did Dike Overtop? _
Follow -Up Inspection Needed?
Engineering Study Needed?
Names of inspectors --A - W1.
G. f� f
f�
Freeboard, Feet 70 - -
Top Width, Feet Z
Downstream SIope, xH:1V 414- IV
Yes No If Yes, Depth of Overtopping, Feet
Yes No
F
Yes % No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes `� No
Other Comments
5

• 1,
Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility f 5, c�s�„ct� - 5 P_ pg 3cs
Ar
Owner's Name, Addressa14 d,SEZ__
and Telephone Number
Date of Inspection ! Names of Inspectors
Structural Height, Feet G Freeboard, Feet - -
Lagoon Surface Area, Acres ?j Top Width, Feet S +
Upstream S1ope,xH:IV 4v', l ✓ Downstream Slope, xH:IV t12' K
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
five Cover
(Grass, re es)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes No If Yes, Depth of Overtopping, Feet
Yes No
f
Yes 14— No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes . '--/,_No
Other Comments

Facility Number Date of Inspection
Time of Inspection � 24 hr. (hh:mm)
� Permitted 0 Certified p Conditionally Certified p Registered p of peratrona Date Last Operated:
Farm Name: Brig.Sraok.#1.,&.#2....................................................................................... County: Duplin WiRO
OwnerName: Staiaky................................... James.......................................................... Phone No: 2.85.A7.7.3....................................................................
FacilityContact: ...............................................................................Title................................................................ Phone No:....................................................
MailingAddress: 5M.JS.NC.5.Q......................................................................................... W.allace—AC ........................................................... 28.46.6 ..............
Onsite Representative:.......................................................................................................... Integrator:Mlxrphy-Family-FatriatS......................................
Certified Operator:Linwood.F........................... Hendersian ...................................... Operator Certification Number: 190.64.............................
Location of Farm:
Take.NG.kaw lJ..txa bt.s�f Pimhasrk..� txxnt.rx t.QnttQ. H.48 Q > ............................................ .mileam.rA.::::::..................:::::::::::::::::::::::::::::::::::::::::: ........
w
Latitude ®•®° ®�° Longitude ©• ®� ©°�
Design .^ Current,.
Swine. Capacity, Population
❑ Wean to Feeder
® ee er to finis t
p arrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
-
❑ Gilts
❑ Boars
esign CurMt Design Current
Poultry Capacity•• Population Cattle Capacity Population:-
❑ airy
❑ Non -Layer
❑ Non -Dairy
❑Other
Total Design Capacity 7,344
Total SSLW 991,440
❑
aye,
Number of -Lagoons - ❑ u sur ace rams resent ❑ Lagoon Area ❑ pray re rea
'1-Iolding Ponds 1 Solid Traps- � ❑ o Liquid Waste
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? E] Yes ❑ Na
Discharge originated at: ❑Lagoon p Spray Field p 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? ([f yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
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 ❑ 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 ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard(arches): ............... 2.4............... ............... 3.0............... .................................... ................................... ................................... ...
5.' Are there any immediate threats to the integrity of any of the structures observed? {fie/ trees, severe erosion,
seepage, etc.}
3/23/99
❑ Yes ❑ No
Continued on back

Facility Number: 31-159 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[:]Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[]No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
(]Yes
[]No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
[]Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No .
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
N43'viatations-or. deficiencies -were -noted during. this :visit.:Yalu, will:receive na farther ::: :
......................... ... ...... .. .. ..
-,correspo6dence. about this:visit:: : :
cane t iova Assessment w
freeboard available and lagoon 91 and #2 are in tact. No seepage, no erosion, no enbankment sliding. Both lagoons
good vegetative grass cover.
Reviewer/Ins ector Name '� T
P Alan
= - Cry Koontz (DLQ) _ - 3
W W
Reviewer/Inspector Signature: Date:

p_ [y Division of Soil and' er.Conse6ation'-�Opecadon Review. ,
13 Division ofSoil and Water Conservation .Compliance Inspection s
YDtvisiop of Water Qualr Compliance Inspection
Other'Agency _Operation'Review
Routine 0 Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection aG 24 hr. (hh:mm)
*Permitted © Certified [] Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: :....... County:........ ....................
`I--\ .p..........................................
............ ��' ..................................................................... .......
Owner Name: ........................................ Phone No:................
Facility Contact: ............................ ...... Title:.............. Phone No:
MailingAddress; ............................... .....................................,:...................................
Onsite Representative:...y�� ?
........... ........
Integrator:........ �......
..........�' ...................................
................................................
Certified Operator:................................................................................................................
Operator Certification Number:..........................................
Location of Farm:
....................................................................................................................................................................................................................................................................... .
Latitude �� �° Longitude
Design Current Design en Currt_, = Design Current
Sii+ine
Capacity Population Poultry _Capacity P0pula66ri Cattle Capacity -Population
❑ Wean to Feeder
EP—eeder Finish
71PLI
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons ® ❑ Subsurface Drains Present Lagoon Area ❑ Spray Field Area
Holding'Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes " C No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other.
a. If discharge is observed, was the conveyance roan -made? ❑ Yes ❑ No
h. 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 bio
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CR'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .......... .................. ........ a'................................................................................... ...........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes KNo
Continued on back
3/23/99

Facility Number:rl ` —1:511 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(:]Yes
XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
X No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
[-]Yes
allo
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
XNo
12. Crop type S�1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
CKNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
RYes
❑ No
15. Does the receiving crop need improvement?
CKYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
14 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
XYes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
(ie/ WUP, checklists, design, maps, etc.)
2fYes
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
&Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit? '
(ie/ discharge, freeboard problems, over application) ElYes D(No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes COo
24. Does facility require a follow-up visit by same agency? ❑ Yes RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 6No
0*o yi. . . . r. ..deficiencies sere noted dixrin. �. ... s .... . . . i eceiy .Rio .. .. i.. .
.. correspondence. a:b' ' f this .visit.. . .. ' . ... . . . .
Comments.:(refer to question #) ,Explain any. YES answers and/or any recommendations or any other comment7.
s. =-
Use -drawings of facility_to better explain situations. (use additional pages as necessary) -
GQ�-.
l.� �+�-� �c�, {� � ,t pia � c4�` ►-tee � L--, ���s.�--�, s��..�� � l��e (.
so ; � hrs ��, c-�� �C-tj-e �-:.� lye v� � ;•-� �� e,�
pw� w 1`Ie� �. ►tee r,�-e�� ��L� t
�l ��-� .�.--',�-�'�. �s ��-•�.:���� by say 1-� — l �S I.���t+-e
Reviewer/Inspector Name 1
Reviewer/Inspector Signature. Q Date: —CIM
3/23/99

Facilfty Number:3 —1561Date of Inspection 1I J 1
Odor Issues
2&
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below
)qYes
❑ 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
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
0 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
34.
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
,P�TNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
eKNo
32.
Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover?
❑ Yes
ANo
Additional omiinents an_. ot: rawin
`�• �:et.� �l�-�=���4� �s�►-���� Ott--. ►-�� . ����t��,���t�-�.L,
3123/99

40 Lagoon Dike Inspection Report
Name of Farm/Facility ? I- /5-�7
Location of Farm/Facility
Owner's Name, Addressand Telephone Number 1
Date of Inspection l Names of Inspectors /ti-{,c,".s:,_
C<:-Q
F it
Structural Height, Feet Freeboard, Feet - -
Lagoon Surface Area, Acres Top Width, Feet
Upstream Siope,xH:1 V 4u', l_✓ _ Downstream Slope, xH:1 V
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
five Cover
Q
t9rrees)
Did Dike Overtop?
Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes I-/— No
Is Dam Jurisdictional to the Dam Safety Law of 1467?
Other Comments
Yes No

Lagoon Dike Inspection Report
Name of Farm/Facilityl
Location of FarmlFacility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH: IV
Embankment Sliding?
(Check One, Describe if Yes)
q/,22
Yes_ No
Seepage? Yes —y No
(Check One, Describe if Yes)
Erosion? Yes _� No
(Check One, Describe if Yes)
Condition of
Names of Inspectors
c. �0
Freeboard, Feet 7. rr -
Top Width, Feet
Downstream Slope, xH:1V
Mive Cover
Trees) - -
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes_ No
Other Comments

Division of Soil and Water Conservation [3Other Agency
® Division of Water Quality
Routine O Com taint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection �24 hr. (hh:nun)
13 Registered 0 Certified. © Applied for Permit © Permitted JE3 Not O erational}}��j Date Last Operated:
Farm Name: y:...,1.ruoii`.........................................
.........U;1D...�..`�":.'--..... ............... Coetnt ,..r.............
Owner Name:...........s. ..........'....
...................................................... Phone No: ... fbi.s"..'[77.3 ............................................
Facility Contact: Q !�$................ Title:..... C1l�1'
.
�rPhone No:
......5 ................ ....... .........
Mailing Address:..... C �7..... E f.S... N..rr...... ..................... . k.. I S.....
............ .......................................................... f... t................
Onsite Representative:........ ..: wt.q�s.............................................................. Integrator:.......
Certified Operator................................................................................................................ Operator Certification Number,...................... ...........
Location of Farm:
%.xx `.....a s......Qx1........14...1,....°.... an....5� ........5 i t .�...1 y.....1``3�,? s...........a .......... �i.:.................................................................
........ .............................. ......................... ... ........................ ... ....................................
Latitude 0 6 SS " Longitude =' ®' "
. Destgn CurrenE
;De`sign . Current Design Cnre ent
Swore' Cap actty,,Population
Poultry.
Capacity. rPopulation Cattle Capacity Population
_. _....
❑ Wean to Feeder
I
I0 Layer
JEI Dairy
Feeder to Finish
JE1 Non -Layer
I
I
1E] Non -Dairy
5'•
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other'
El to Finish
Tuta1 Design Capaclty
❑ Gilts.
Tote SSLW Cj 3
[I Boars
5
NuiEnber of Lagoons 1 Holding Ponds r�' ❑ Subsurface Drains Present ❑ Lagoon Area t] Spray Field Area
X FEI No Liquid Waste Management System
General
1. 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 lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [21 No
❑ Yes M No
❑ Yes [0 No
❑ Yes No
❑ Yes No
❑ Yes
® No
❑ Yes
M No
® Yes
❑ No
❑ Yes
bg No
❑ Yes
59 No
Continued on back

ility number: 31- S
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lay-oons-.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:13..�..:................#.....Z....................................... :.....
Freeboard(1t): ..........$......................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
,� Na
❑ Yes
® No
Structure 5 Structure 6
.................................................................
❑ Yes
® No
® Yes
❑ No
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)
i
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP. or runoff entering waters of the State, notify DWQ) ,
15 Cro ty e i,.i A
V] Yes ❑ No
❑ Yes No
❑ Yes No
t
p p ••--- ....... . LY7iW ............................................................................... I .... ...
..........
.............
.............
...................
..-..............
.............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMPP ElYes 14 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes M No
18. Does the receiving crop need improvement?
19. ,Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No.violations or deficiencies were'note'd during this visit.:You.will receive no flirth�er
correspondence about this -visit.. :.
❑ Yes R3 No
❑ Yes 91 No
$] Yes ❑ No
❑ Yes X No
Y1 Yes ❑ No
M Yes ❑ No
159 Yes ❑ No
❑ Yes ❑ No
Comments'(ieferto question #): Explain any YES answ rs and/or any recommendations or any other commnts el
Use drawings of•fucility to better explain'situations. (use additional pages as.necessary)
_
T. Wl,�,. a,�1°""g` tx�trn�t►� �L�,t. PIQ« P Tf� '�tiin o� ���- s� de e f ��a� ►ro'yt�c..u�s ..,x,...
1'AI , r'rrasbk a.v-1 as- +1- 4 t►t %a� C.- W.sl l o f f,Sao 81 sl-ot 6t c..lr.,, o,-d vt-tm),e d� scut
a or-, \%A�1rvxt s64 be Pt-sP_d4-
Zt. Lyeo,Jd"IKsSiuvvld 6P__stn CkW*P. -V1oj rcey5 �hoe)j 6- 1L441 � Vq +1WJV-,V41- Comef
CALEi,"-�
2,3 . iriri�tt� cr t'r[1?y�s ht1t� i'kYdLi�l}bl� �4' T+� � inS7{C.G�br`..
f Wtvt
vq� Fik �1l f r� s 0,bt-
i ti �ttr. oas S+�Dui� Rif h� s1►W��e� �c1 Tom••. Yfn,, 7/25197
Reviewer/Ins ector.Name x E
p y
Reviewer/Inspector Signature: Date: Vie

r
❑DSWC Animal Feedlot Operation Revlew.
��
�. � �
DW Anlmal Feedlot 4peratlon Slte �nspectlon
Routine 0 Com laint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection g; 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel and rocessin
❑ Not Operational - Date Last Operated: _.. _.. _........... � .................�........._......-............... _..... _ ....
FarmName: __......-L�[K..._............. __...._._............ _........ ._...... County:.f1C1........ ......_ ........., __.._ .....__ .
Land Owner Name:... ..�J�i� .. ._ .... _....... _ ..._ .......... Phone No: �l r' .471.E .
Facility Conctact:............�i� �.o( 4..... .......... _... Title: ._lF.t ibk! .... ..... ..... » ...._. Phone ,......
Mailing Address:......_<..SA......��c. �1�...'s�....._.... _....._._..... ......... I ...... A11jMF..... LjJ(1 ............... _2-mh.L... ...., _....__ ..........
Onsite Representative:......s�� .Qu�,.�.W ...._----�.................... ._...._ Integrator:
Certified Operator: .. _ .... � ....... ................. Operator Certification (Number: �• .
Location of Farm:
Latitude �• ®� ®u Longitude ©• FJ
Tvne of Oneration and Design Canacitv
.� ; ,.3a4— x _
ign Current D�ga Current, Ibe sg �nC Desurrent a.
.....
Poultry Ca acity xPo ul8tlona Cattle Ca aci ' Po " ulateoa
, Ca ace �'I'o ulation ,. o _ .
❑Wean to Feeder z I❑ La ; ❑ D
Cd Feeder to Finish ❑ Non La er ❑Non -Da
Farrow to Wean
-$ Farrow to Feeder "Total Design�Capae[y 3 lufE,.
Farrow to Finish' -
_ mmu,
0 Othe
otal SSLW
Number ofL,agoflns I Hol�mg Ponds 1 r ❑ Subsurface Drains Present4
❑ Lagoon Area ❑Spray Field Area
General
1. Are there any buffers that need maintenancelimprovement?
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 Watef? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaV:nin?
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 5[No
❑ Yes $0 No
❑ Yes
[& No
❑ Yes
No
❑ Yes
® No
❑ Yes
t6Y No
❑ Yes ® No
❑ Yes [f No
Continued on back

1
Facility Number: .J].......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures CLau om and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4
2.:...... ........_...... .... _...._........ .. .... .._.....
...... -
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
❑ Yes
91 No
❑ Yes
Ej No
❑ Yes
C9 No
Structure 5 Structure 6
Wastt Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
�..
15. Crop type.....................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
Eor Cerdfied 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?
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)y
❑ Yes JA No
09 Yes ❑ No
® Yes ❑ No
❑ Yes 18 No
❑ Yes N No
❑ Yes IN No
❑ Yes (allo
❑ Yes $l No
❑ Yes 00 No
❑ Yes JA No
[I Yes F] No
❑ Yes 6a No
❑ Yes P No
❑ Yes ® No
P-/}2. Evvs11tet. &r m prn Ntu- kall 6� j4yoy,-skov)J lhe 4tl.La &J rtseedeJ, &r� s?ON -5AoOJ r
^bleed e_t� .
Reviewer/Inspector Name
Reviewer/InspectorSignature: 3 - �)�,,�� Date: �lJQ7
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

0
Site Requires Immediate Attention:
Facility No. — !
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO SITE VISITATION RECORD
DATE: .1995
Time: a'P�
Farm Na
Mailing.
County:
Integrator: !/ Phone:
On Site Representative: %�ilt�� % �'� Phone: -9,85t V-773_
Physical Address/Location: / - ly - "/
Type of Operation: Swine
Design Capacity: J& 2
DEM Certification Number: ACE_
Latitude: q, ' q�t' 'S-1 "
Ar
Poultry Cattle
Number of Animals on Site:
DEM Certification Number: ACNEW
Longitude: 77 ° q q- ' —4/0 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon ove-i.cient freeboard of 1 Foot + 25 year 24 hourstormevent
(approximately 1 Foot + 7 inchesNo Actual Freeboard: Ft. (D Inches
Was any seepage observed from(s)? Yes cN Was any erosion observed r No
Is adequate land available for spra ? Yes orr, No Is th cover crop adequate? Yes 0 �A�,('r
}
Crop(s) being utilized: 1 A �11 reP
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Ye No
100 Feet from Wells? /'?e44 No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes 60
If Yes, Please Explain..
Does the facility maintain adequate waste management records (v2kmes of manure, land applied,
spray irrigated on specific acreage with cover cro )? Yes kNo
Additional Comments: �/ m ) S Ue e1rl F1 -e-
Inspector Name
cc: Facility Assessment Unit
5
Q e AJ
O d0 f ri-L P , 4AIrt t
S' ature
-4'e6v15 t.T- /AJ
Use Attachments if Needed_
41

Site Requires Immediate Attention: -A b
Facility No. 4� 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S SITE VISITATION RECORD
• ��71✓c�p�C-%1D1� DATE: ® .31995
Time: 9, j�
lc �
Farm Name/Owner: gn
Mailing Address:
County: i 0P61AJ - -
Integrator, Phone: ,a" CI
On Site Representative: 1 L� GL Phone:
Physical Address/Location:: �3/0/� ,�^� /��1 .f- aye a)
j//J
Type of Operation: Swine Poultry Cattle
Design Capacity: 70P Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: __� I/" V(4,' 3S " Longitude: q T' 3 Z " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hourstorm event
(approximately 1 Foot + 7 inches Yes r No Actual Freeboard:�Ft. & Inches
Was any seepage observed from the lagoon(s)? Yes qFr 9Was any erosion observed? Yes r No
Is adequate land available foh spray? Yes or No Is the cover rop adequate? Yes r No
Crop(s) being utilized: �4�Y.�"L GJ� T+�—� . Alp Y9-Y cJ�°
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es r No
100 Feet from Wellsl Ye r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional) Comments: e7.40- ] '! A� & -t2e0f -d OW 626
E- Mitt- )-Sc-
• Inspector Name
Si
cc: Facility Assessment Unit Use Attachments if Needed.