310161_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Qual

Type of Visit: Q.Com ce Inspection U Operation Review Q Structure Evaluation U Technical Assistance -
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 3 f Arrival Time: Departure Time: (Z o County: . Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number: I l g—p T,%—
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Design Current
Wet Poultry Capacity Pop.
La er
El
Design Current
Cattle Capacity Pop.
Da' Cow
Feeder
Non -La er
Da Calf
o Finish
4 �1,3 r
DairyHeifer
rFarrowo Wean
oFeeder
o Finish
Design C+urrent
D , P�oult , C•a aci jr
La ers
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 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 o ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes F2 No ❑ NA . ❑ NE
Page I of 3 21412015 Continued

Facility Number: 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier: i Z
Spillway?:
Structure 3 Structure 4
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in): 7 If Z.. 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Hj'iVo ❑ 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 lG Ko ❑ 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 reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes nNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes 9�0>00
NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ���00
NA ❑ NE
L$. Is there a lack of properly operating waste application equipment? ❑Yes 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 E'<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 P ❑ 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 2-1qo_ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - J& Date of Inspection:
24. flid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M-No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 07N_o__❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No fA M 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
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 0 No ❑ NA ❑ NE
❑ Yes ;"' ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑mar-~ ❑ NA ❑ NE
❑ Yes 7:J- ❑ NA ❑ NE
❑ Yes [:]No ❑ NA 0 NE
Reviewer/Inspector Signature: t _ Date: 3 17
:
Page 3 of 3 21412015

JI- _. v v _F'. wuv..." ..... v _........ -......�....v.. v . r.............-----......-
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f `{ b Arrival Time: + t< S- Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: C Title:
Onsite Representative: J `ram r"�y
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Region:
Integrator:
Certification Number: t
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Design Current
Wet Poaltry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
P:XLlon-Layer
a er
Dai Cow
Wean to Feeder
airy Calf
eeder to Finish
3 A fr
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , Ploult , Ca ac_ity P.o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and 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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify 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
[IT —No
❑ NA
❑ NE
❑ Yes
©' l�o
❑ NA
❑ NE
Page I of 3 21412015 Continued

• Facili Number: 7 - / Date of Inspection: / j(o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FZ�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l ?I- 3 114
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): IZ4
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 [�o
❑ 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 EJNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q N
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of 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 E2-lqo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z*Ro
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[fNo
❑ 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
[]'Flo
❑ 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 o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

• Facility Number: jDate of Inspection: ! b
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I__I No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [f—No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E]�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
[21"go
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[� o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
[�No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0'-No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any -
other comments. -71
Use drawings of facility to better explain situations (use additional pages as necessary).
1.
rcl.— cr y5 iA p cfu k
rc C-o! -js
l✓� s Gay.' /. x a f'-.
I Q 16 S G 9 4,.-<,1•�
rofr er o /p�J ,L. a/..
f 171r�C/ G► f•r Z1� tP
a . 4 n i` O -'1/_ aEf (j D N' 1/ 7y a �( O Y J /� , .�L l •. �a rs S Av e
Srn Ci P j", C) & C o p y pt— /i t l.� / L� � Jet
/z �
4 s � (� Iiv. � � 7 ? �9 Zoe � � r ��.,- � L , �ti r•.-� t'(Q ncd�� r
-J ev
? O & 3 l �• cl� C S� �- e y d we
Reviewer/Inspector Name: 9 zirlit (1 Y a. -,-e
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7
Date: r i
21412014

(Type of Visit: 0Co ance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q�up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: ZZ / Arrival Time: 0 31-. Departure Time: // County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title:. Phone:
Onsite Representative: �� Integrator:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Certification Number: I f kC27
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
DairyCow
Design Current
Capacity Pop.
W to Feeder
Dairy Calf
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P■anit , Ca aci P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Boars
Other
Other
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes [D 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 0 No NA NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
No
[] NA
0 NE
❑ Yes
[5to
NA
NE
Yes
FfN.
NA
NE
Page I of 3 21412011 Continued

Facili Number: -J61 jDate of Inspection: Z Z
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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): RR
Observed Freeboard (in): 40 3 k-' J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E]"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [2 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes E No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
l I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesFJ'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ 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 dNo. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
; ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

aciii Number: - Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes CdNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
�NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes &No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ENo
❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes &No ❑ NA ❑ NE
❑ Yes [Z] No ❑ NA ❑ NE
❑ Yes EfNo
❑ Yes [f o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
�L . 5 (9.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 01 Id
Date: x
21412014

Tadlber 3
_ t
Division of. Water,:.Quahty
0 Dw,isiiin of Soil andxVl'ater,Conservatzon
-Other Agency m
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit utine 0 Complaint 0 Follow up Q Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: y3 Arrival Time: dG Departure Time: County: D& l/2 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: ✓ Z'&
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:11'-T
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 r, Longitude: = o =
Design Current Design Current - - wDesign�CurrenE=
Swine kV t Poult "'�
Capacity, Papulat�on %- ry . C,apscity Poulahon �„ Capacity Po'p�ulation
7 El Wean to Finish 1 1,101-ayer I Dairy Cow
❑ Wean to Feeder > ❑ Non -Layer I I ❑ Dairy Calf
El Feeder to Finish " '" �~° E] Dai Heifer
❑Farrow to Wean » Dry Poultry ' R - _ ❑ D Cow
❑Farrow to Feeder ❑ N D
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.... ��' ,�, � �� � k �•�..�
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
FuTurkey Paults
❑ Other
on- a�ry
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Numbe o Strtictures.�O'
Discharees & 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?
❑Yes,kNo ❑NA ❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ,�No
❑ NA
❑ NE
❑ Yes ,t/I No
❑ NA
❑ NE
Page 1 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 PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Struc re 4 Structure 5 Structure 6
Identifier: / a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )!fNo -❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gfNo ❑ 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 ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )6No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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?
❑ Yes
�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZJO'VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question.#): Explain any YES answers and/or any recommendations or any outer comments , w
Use.drawings'of facility to better explain situations. (use additional a'ges'as necessary)
G orbs �D4� joa6o'-
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Page 2 of 3
I�fv Phone:
Date:
1

Facility Number: Date of Inspection 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ff No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ 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
(KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Plio
❑ 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
dNo
❑ 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
ONo
❑ 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
{o
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
' 77777� n=
2.e
G • 73
1)r/e4j 4ell 641/1 1714/1 s/mac
G• ,i'ro
Page-3 of 3 12128104

u
3
Type of Visit Z Compliance inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint Q Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: a.3 Arrival Time: 'Q Departure Time: County: �� Region:
r^
Farm Name: J I✓ a4L f %ln S _ Owner Email -
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: JAle
Certified Operator:
Phone:
Phone o•
Integrator:
j
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= e = i = Longitude: 0 ° = ` = "
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
Capacity Population
to Finish
❑ La er
❑ Dai Cow
FE]Wean
an to Feeder
❑Non -La er
❑Dai Calf
❑ Dairy Heifer
eeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ Layers
❑ Non -Layers
El Beef Stocker
El Beef Feeder
❑ Gilts
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
10 Other
Number -Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ 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
No
[I NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
I-
[�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 3 — Date of Inspection Ep�oe
Waste Collection & Treatment ,�
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ,� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Stru re 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 ,KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
El"o
❑ 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
gNo
❑_NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P(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
ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
FrNo
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
WrNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]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?
❑ Yes O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes eNo
❑ 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 ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �eNo
❑ NA
❑ NE
'Co mments (refer to`question.#): `Explain any YES answers and/or any reCommendat10n5 Or anytother Comments
Use drawings of facility. to better explain_situations (use addihonal pages asnecessary): �, R w
�.
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature:" / _ Date:
Continued

Facility Number: 3 Date of Inspection ?-3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Rl�o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �2 io ❑ 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 pen -nit?
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? (ie/ 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 ,E ivo
❑ NA
❑ NE
❑ Yes �Mo
❑ NA
❑ NE
❑ Yes �No
❑ NA
❑ NE
❑ Yes 7No
❑ NA
❑ NE
❑ Yes eNo
❑ NA
❑ NE
❑ Yes ,0 No
❑ NA
❑ NE
❑ Yes PKo ❑ NA ❑ NE
❑ Yes PKo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
[--]Yes O/ No ❑ NA ❑ NE
❑ Yes JO No ❑ NA ❑ NE
❑ Yes ❑-Ko ❑ NA ❑ NE
Additional Comments and/or Drawings._.
Ak
12128104

Facility Number 3
�Divtsion °of"
-0 D��ision oft
V
(Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit fi� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 . rrival rime: eparture Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Pho a No
Integrator:
Operator Cer ' ication Number:
Sack -up Certification Number:
Latitude: = 0 = 4 = Longitude: [� ° = g
R Design'.., Current Design h
Swine Capacity" Population Wet Poultry ,:CapacitS P
❑ Wean to Finish 10RLayer
a ❑ Wean to Feeder 10 Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean :Dry Poultry�� ;
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
(other
❑ Other
❑ La ers
j
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dairy Cow
Dairy Calf
Dairy Heifer
DryCow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood {
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?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[-INE
❑ Yes
I
❑ Yes
No
❑ NA
El NE
❑ Yes
�No
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of inspection V 1,7111-
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
}o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Stu 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
9,No ❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
//
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[,YNo ❑ 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
L�J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Cl Yes
�No ❑ NA El 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
XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes91'
No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
&No
❑ NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name f phone:` b
Reviewer/Inspector Signature: Date: d
Page 2 of 3 12/28/0 Continued

Facility'Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 25"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZfNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. El Yes ❑,No ❑ NA El NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste 'Transfers/❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes
J;2�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
gKo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Xo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[:]Yes
eNJ o
[I NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,?J No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[--]Yes
pio
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
grNo
❑ 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
RNo
❑ 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
ElYes
,
4CJ 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
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes o ❑ NA ❑ NE
Additional Comments and/or. Drawings..
Y / CCU/
c6
Page 3 of 3 12129104

Type of Visit (>,dompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visitoutine Complaint Follow up Referral 0 Emergency Other El Denied Access
Date of Visit: Arrival Time: l(it Departure Time: County:Z&aL Region: f1j
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 'q ':6-f 62 r-"6,
Certified Operator:
Back-up Operator:
Location of Farm:
71 _ Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = 5 Longitude: ❑ ° ❑ t
Design
Swine C►apacity
C•+urrent
Population
Design
Wet Poultry Capacity
Current Design C►urrent
Population C+attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer I
I
❑ Dair Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Layers
[I Pullets
❑ Turkeys
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
❑ Other
❑ 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)
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 �Ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Olo
❑ Yes
[No
❑ NA
❑ NE
ElL' Yes
El"No
❑ NA
❑ NE
12128104 Continued

Facility Number: • — Date of Inspection ci
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struct e l Structure 2 Structure 3 Structu e 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 PNo ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes o ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes P'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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [INo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EfNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ INo ❑ NA ❑ NE
RrNo ❑ NA ❑ NE
No ❑ NA ❑ NE
ZfNo ❑ NA ❑ NE
0No El NA El 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):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: )
Page 2 of 12/2 4 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑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 ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
PTo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,allo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�Ixo
❑ 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 2TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ErNo
❑ 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
0"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
❑'Po
❑ 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
PNo
❑ 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
ZFNo
❑ NA
❑ NE
12128104

ivision of Water Quality
Facili . Number Q Division of Soil and Water Conservation
�' Ill
Q Other Agency
x
F
f Visit compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
n for Visit ,routine Q Complaint Q Follow up Q Referral Q Emergency O Other ❑Denied Access
Date of Visit: Arrival Time: :" Departure Time: County: Region:
Farm Name: r ! Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Num er:
Back-up Certification Number:
Latitude: = o = d 0 « Longitude: = ° = i
Design Current
Swine C►apacity Population Wet Poultry
Capacity Population
Design CurrentrDaiyC]lf
Design C+urrent
Capacity Population
❑ Wean to Finish
❑ La er
Cw
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
Dry Poultry
FMLayers
❑ Non -Layers
Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Beef Stocker
❑ Beef Feeder
❑ Boars I I ❑ Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
❑ Beef Brood Co
Nurnher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
El Yes
IJNo
[I NA
El NE
12128104 Continued

Facility Number: - 6 Date of Inspection I
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 ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: [}-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2No ❑ 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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ['No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑l% o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EYNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ jNo ❑ NA El NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;2-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes J2" No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Q'No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes ❑N-6 ❑ NA ❑ NE
1-11
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):
1
Revrewer/lnspectar Name Phone: Z11q-Tr - �,�
Reviewer/Inspector Signature: l Date: Q
Pape 2 of 1 /28/04 Continued

Facility Number: — Date of Inspection
. Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ i Io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;3 No ❑ NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? )Z Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
,ZNo
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
go
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
.Ef 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
MNo
❑ 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
ENo
❑ 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[;No
❑ NA
❑ NE
AdditionaiComments and/or Drawings:.
�. r
• �l1C�C GtQ� %1eC�✓ ��5�
�6
a • 7
emla�y,Vs A, ezl-e
a .
i A .,
Ile, rc l." YS/�S J
f! /A j
105
3_ o
�, ff
Y t s IrL
a r
Page 3 of 3 12128104

Date of Visit: Arrival Time: Departure Time: County: i/f./Y/!/l-
Farm Name: = 1Z �O � r"2g Z — 7 Owner Email:
1/ Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finishk39'11jX1001
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
ry
Operator Certification umber:
Back-up Certification Number:
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit RKRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Region: � V
Latitude: = = . �" Longitude: = ° = 4 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes _P'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑-No
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
12128104 Continued

Faciiity Number: Date of Inspection T 6
WastZ Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &a<o ❑ NA ❑ NE
' a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 7 7 % 7
Observed Freeboard (in): v� o'Z 60 3cD
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Z No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes •❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ErNo ❑ 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 ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �?&o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Plo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 1016s ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acce table 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 fJ—No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes JEJ-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes 1 -No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZI No
❑ NA
❑ NE
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: d O
12128104 Continued

Facility Number: EaZ Date of Inspection G
Reguired_Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;�Vo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check JfTYes ❑ No ❑ NA ❑ NE
the appropirate box. tzn ❑ Maps p El Other
❑ WUP El Checklists �esi
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ClNo ❑ 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? (ie/ 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 IWNo
El NA
ElNE
No
ElYes ElI
IAD
�A
❑ NE
❑ Yes ENo
❑ NA
❑ NE
❑ Yes .'No
❑ NA
❑ NE
❑ Yes ,allo
❑ NA
❑ NE
❑ Yes ErNo
❑ NA
❑ NE
❑ Yes ,ErNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
El Yes L7No ❑NA ❑NE
Additional Comments and/or Drawings:
'026 1 e z e� co f � 1ar. oo�-, e-vi-ns
si k reca�t�'_
ea CA
l2/2&04

(Type of Visit O Copfpliance Inspection Q Operation Review O Lagoon Evaluation
for Visit d Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Bate or Visit: (a 6 Time: i �30
O Not Operational. C Below Threshold
Permitted dCertified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
_" %gID'-7 F IZ runt l -`
Farm Name: � '
Owner Name: . ..... ................._W.._ ...._....... _._ ..... ............_.. Phone No: �. _ ...
Mailing Address: .. . . . ............. . ..................................
FacilityContact: ...................................... ................. .... _.......... Title: .._...... ...................................... ............. Phone No:..... .. . .. ........ .... ................. ---.....
Onsite Representative: STD/ �it�AD Integrator:.... M ��. ................. ----..
Certified Operator:_...._....- . . . .......... . . . ... .... ___ .._.__ . _.. ............ Operator Certification
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude • 4 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes /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)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ......... ....j......... ........... ................4----- -.................. .3....... ............ ......... ........................................................ .......
Freeboard (inches): 30 2 (p 27 IP- 7
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0
❑ Yes
Ta
❑ Yes
[a' Io
Structure 6
12112103 Continued

Facility Number: (— j Date of inspection (�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
M No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[/No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
ZNj
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancermprovement?
❑ Yes
[ NN
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
ElYes
t_d�o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
in
yNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ yes
2
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type \1 t*1Z.W►VDb [ 5 GO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Ng
14. a) Does the facility lack adequate acreage for land application?
El
—�' gN
b) Does the facility need a wettable acre deternunation?
❑ Yes
1��'N/
c) This facility is pended for a wettable acre determination?
❑ Yes
To
15. Does the receiving crop need improvement?
❑ Yes
�o
16. Is there a lack of adequate waste application equipment?
❑ Yes
l/o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes � oo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes p o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes /No
Air Quality representative immediately.
Comments (refer tEe gnesfian) Explain nay YFS answers and/oc airy recommendations or any offer comirients. m
Use drswuigs of �c�'ity to better ezplarn sitnatr4ns (nse addrhoina! page`s as n�ssary) � �: [] Field COPY ❑Final Notes
-�2�NS�R.- �N102�1LSTY �E3 1�Rovfi�� F6 fL-d1�. •
IC�cP �aP`i' o� ArJn1UR� C�.�.T w.�.YN REc�.s.
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: 31 — j (, j Date of Inspection (m j 31Q�J
Re aired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes /No
❑ Yes
© Yes Vo
❑ Yes /No
❑ Yes
❑ Yes BeNo
❑ Yes B<O
❑ Yes Q ixw❑ Yes
es ❑
❑ Yes
❑ Yes _o
❑ Yes [.•31�,6
34. Did the facility fail to calibrate waste application equipment? ElYes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit locompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification
Facility Number / Date of Visit:
O Permitted ©Certified [3 Conditionally Certified 13 Registered
Farm Name: & r,4A v' s T
Owner Name: TE. 61
Mailing Address:
Facility Contact: Title:
Onsite Representative: B y� ��a y tn elf k- _�rs+
Certified Operator:
Location of Farm:
Other ❑ Denied Access
03 Time I =O
Date Last Operated or Above Threshold:
County: uI
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude �� �4 Du
Swine
❑ Wean to Feeder
Design Current Design Current Design Current
Ca aci P.a ulat'on Poultry Ca aci P,o ulatian Cattle Ca acity P,o ulation
❑ Layer 10 Dairy
❑ Feeder to Finish
❑ Farrow to Wean
❑ Non -Layer JEI Non -Dairy
❑ Other
TOtal Design Capacity
TOtal SSLW
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons L J
Holding Pvnds 15olid Traps
❑ Subsurface Drains Present ❑�LagoonArea ❑S ray Field Area
❑ No Li uid Waste Mana ement S
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. tf 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: 2 3 ->r
Freeboard (inches): �0 23
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
[I Yes
[I No
,e Yes
tructure 6
❑ No
Continued

• Facility Number: 31 — f Date of Inspection SI
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 property 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 Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Pending ❑ PAN OElydraulic Overioad Oyes ❑ 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?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )21ONro
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [:]No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
facilrtyto better explainTsituations. (use,addiUonal�pages as necessary) f g
r ,. ❑ Field Com ❑ Final Notes
.. :: _ .. i . k ,: - — s _ ._ _ _
Alt , S i nspec- i o n Was dor15, LDS of -t4reeboo 14 oh eGk . DL, -f e
/moo •h et 4'1�0 v4er pC'G�'o►�
en 7I�lo3 As' !-,Qtr;•`9 _Tw Vle we -sae rDjto fr rdr'1 7 "[e SP►^4�f^,'gll�(
+h-�o eL /,A r9e Gee.►/ h o le w {4IN s{a,�d.i.�X a�e�; ��i f �lo/e of wq gyp/
vloes ou�•fq l ( �p S� �-�'a GP L✓df e�f . �l� b�q� darv►►�ter,( tie o iz4le4 -�
S- AO pv -/Af ha/e ►`n fay1"0011. sq.�,,P/Ls I
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
rc
Date: 7 31
05103101 Continued

Facility Number: '3 Date of Inspection 3/ D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ 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 ❑ 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 ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments andlorDrawings::
were
05103101

Type of Visit OCompliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine O Complaint XFollowup O Emergency Notification O Other ❑ Denied Access
Facility Number I
Date of Visit: L
O Permitted 0 Certified 13Conditionally Certified [3Registered
Farm Name: - r~a� r
Owner Name:. G ra d
Mailing Address:
Time Sf
Not O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County: .V u e l ."A
Phone No:
Facility Contact: / ` Title:'t rL, Phone No:
Onsite Representative: . 5- � „� 6 rid y , ►YA I c 1 C5 �� N �6SQ`t Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 u Longitude ' 9 u
Resign
Swine @a achy
❑ Wean to Feeder
Current Deslgn Current Design Current
P.! tion Cattle Ca aeity Ro ulation
❑ La er ❑ Da'
❑ Feeder to Finish
❑Non -La er ❑Non -Doi
❑Other
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ soars
T 1 De i n ota s �Ca aci
Total SS1
Number of Lagoons
Holding Ponds / Solid Traps
❑ Subsurface Drains Present 10ugpo. Area ❑ S ray Field Area
❑ 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 man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: f — Date of Inspection 1 p 3
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?
(If any of questions 4-6 was answered yes, and the situation poses an
[I Yes
El No
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 ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ 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
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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. Fait 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
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
-T %s rhSroe.e,.jt,✓aS d ane " of 4s1(6wVy . M., • G�aaf s
1►7 v!'d in 4AC Gow W44e- 66fe �j 40 41,e [q�toorl . �)e AG -s
Ts' Le,- c O-C 4ke Gew w'0%4t✓ �O�B 4nd 9��tded
� e4 bQr 3 vr-F'v,ce d rq' 1"AA j e r,-o , 41,,e a I-er-) . -T ,e c ie-t i up
sr S are aro�ole��'cc �4d ✓ We 1ookrd A44ke pAo4,o9,-ajalts FYa►•`
05103101 Continued

Facility Number: S] — / b ! Date of Inspection J D3
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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Coiinments and/oezDrawings:
bcl:eves 4�,,d 4ke
(�rSGDf'O.rq-};Ors i►-+ -�'�P GDt„i t.✓q-�C'r Lamle Was doc t�a rv�o-�ro•-.
4,�P ao � cen + �,a7 'ced J reel . 'w
05103101

Type of Visit %Compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Others © Denied Access
Facility Number date of visit: Time:
Not O erational OBelowThreshold
Permitted ©CertiTed [3Conditioonally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ 1 �?' !� County: 4410111j, _
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Steve L Integrator, ,MV 4dr
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �• OK Longitude r-�0
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes 2�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 Rio
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JK-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M.No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 Z
Freeboard (inches): Z! 4t 3
05103101 Continued

Facility Number: 31 —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?. (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes VNo
❑ Yes ULNo
❑ Yes W No
❑ Yes VNo
❑ Yes LNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q9 No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [!)TNo
12. Crop type 96 Vf— A 4 S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KTo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZNo
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
[gN0
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[51No
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
[RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
RNo
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
QitNo
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 EjjNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes E4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes UNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® o
Ila No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
mments refer to' ieestian #} �ii. Wii_an YES answers-andloc.an recotummea - Ca} ( 9 ) p y y 'dahons or any.oMer comments
liise drawings of facility to better. explain'si#uaf�ans ,(ase addittattal pages:as necessary) ❑Field Cory ❑ Final Notes
/frt bL/Odi took 6;o w.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 4r Continued

Facility Number: Date of Inspection ZC Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below [IYes IRCNo
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [$Vo
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [i�Vo
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 [X No
3 I _ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes No
Additional Comments and/or Drawings:.
0510310I

Type of Visit KCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date )r visit: D p Time.
(/
Not O erational Q Below Threshold
Permitted © Certified © Conditionally Certified 0 Registered Date Last Operated Above Threshold:
Farm Name:
_ r
........��.........4,��..A.........._.1..�..�............................................... County:........ ..................
1 1
Owner Name: ................................................... .... Phone No:
Facility Contact: .� . 1�._....(�.Jr .Title: ........ PhoneNo:....................................................
MailingAddress: ......................... .. ��......_....................................................._..............._...................................... ................................................
OnsiteRepresentative:., ............................ ` 1(................... ............... Integrator:.......................................................................................
Certified Operator: ...................................................................................... Operator Certification Number:.......................... .
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �« Longitude �• �C�«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I 1 ❑ Dairy
eeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars _Total SSLW:
Number of Lagpoons
J
❑Subsurface Drains Present ❑Lagoon Area
❑Spray Field Area ;
Holding Ponds I Sohd Traps
❑ No Liquid Waste Management System
1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water 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 ves, notifv 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?
01/01/01
❑ Yes k(No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes 1KNo
[]Yes KNo
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes L�9 No
�nStruc�re I Structurre," 2 Struct�ur 3 Structure 4 Structure 5 Structure 6/
Identifier: ...!".'. ........ t!v5.. ..... z.d[..............1!1!1►..`K tr........h'!.!1rY?1..._.._..._.........................................................
Freeboard(inches) >�U......................le .......... .............. �.5..1........... .......�.....1................ .................................... ....................................
...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
e) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
❑ Yes : No
❑ Yes -
*Yes ❑ No
❑ Yes f No
❑ Yes �No
El Yes
_]�1\No
El Yes \<No
❑ Yes /No
❑ Yes &No
❑ Yes KNo
❑ Yes o
❑ Yes JTNo
❑ Yes ]�(No
is
ater supp
❑ On -site ❑ Off -site
Required Records & Documents
19,
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
��!!
o
\\
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
<No
�o
21.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
No
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
26,
Does facility require a follow-up visit by same agency?
❑ Yes
No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
%lo
01/01/01
Continued

tacility;Number: — ' Date of Inspection -EP*
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 1/4/2001
❑ Yes kINO
❑ Yes XNO
❑ Yes No
❑ Yes No
❑ Yes t
o
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (r�fer�toqueshoII #) Explain anyYES answers and/or any�Feconunendat,ons or any other comments
moons
Used wregs of #�acth� to Bette plarn s�tuat (use addrhonal pages as necessary) `` M g
x `'`�� Field COPY ❑ Final Notes
�'..�
�--_��:;�' �-��r-�- _--�- _ ,��- �❑
.��
AL
�k�vv►.` S Y Lt�-e�s 1 DbL j yv&x -
`
Reviewer/Inspector Name • �n:��e a z ,� �
.
Reviewer/Inspector Signature: Date: ;I lox
V I
01/01/0I

Facility Number Date of Visit: Time: � Printed on: 7/21/2000
Not Operational Q Below Threshold
k
ermitted Q Ce ' edd © Con�-Va
onally Certified ❑ Registered Date Last Opera r Above Threshold: ........ 1S Countv:..... ........... 1 .................. ...........
FarmName: ......................................................................... '
Owner Name: ....., Phone No: ...•
Facility Contact:. �!;....... .�5................ Title: �![41.i►� r Phone No: ...................................................
Mailing Address:
Onsite Representative:
Certified Operator:
Location of Farm:
Swine ❑ Poultry ❑ Cattle []Horse
............................................................ I.............................. ............... I ...... I...
....... Integrator: .............. I1....'. f.
.......................... Operator Certification Number:
Latitude 0 4 66 Longitude 0 4 69
DesigQ Current
Svi�tt ; .0 apacityPopulation
Wean to Feeder
Feeder to Finish 3O4
Farrow to Wean
k`^= Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nunnber.of Lagoons ❑ Subsurface Drains Present ❑ Lag4xm Area 10 Spray Field Area
'HoWiing PondsY Solid Traps' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
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)
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
Struetur I ,
Str c ure 2
Structure 3
Str cture 4 Structure S
qq
Identifier: ............ ..lr...Ll..............
Z...................�7.
.....................
...........................................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes K10
❑ Yes \\[3No
Cl Yes [)(No
Structure 6
Freeboard (inches):
5100 Continued on back

f,
Facility Number: — Date of Inspection 2 D Printed on: 7/21/2000
5. Are there any immediate th eats to the integrity of any of the structures observe d? e/ trees, severe erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ 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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of ov agplicat�? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type (J/�1 , (f-- 7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over app)ication)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PO
❑ Yes kNo
❑ Yes �*o
❑ Yes J*No
❑ Yes &0
❑ Yes 'No
❑ Yes 6No
❑ Yes KNo
❑ Yes dNo
1
❑ Yes �KNo
❑ Yes [ No
❑ Yes tNo
❑ Yes 6lo
❑ Yes KNo
❑ Yes NNo
❑ Yes %No
❑ Yes .0 No
❑ Yes SFo
❑ Yes BNo
❑ Yes ONo
0. ISO Molatigns'0r deficiencies *!re. noted dix`ing this'visit' - Y;ou will •receive iio further • : -
corres ' deuce. abirut this visit. • .. • • . • .......... .
Cdtniinents (refer to question #}s Explain,any YES answers and/or any recommendations or any otliier.conunents N
Use drawings of facility better explain situations.`{use additional pages as necessary)
Ind 4 =00711�
AL
Name — G
Reviewer/Inspector Signatug _ a///jJ�} j� Date: /rZ�// ////) 5100

G
[Facilitj Number;. I — Date of inspection F77 it Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to th storage pond or lagoon fail to discharge AJor blow ❑ Yes JF(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
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes A3VO
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 '63LN0
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 E5Vo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PNo
32. Do the flush tanks lack a submerged fill pipe or a peimanendtemporary cover? ❑ Yes O$Io
Additional'Comments'and/or. swings:
5100

r= E3 Division of Soil and Water Conservation`-,©peratto6 Revjew.
D Division of Soil and. V' MO Conservation - Compliance Irispectlon t p
P
1 Division of Water. Qualio -:Compliance-Inspectiona
- -
a ;.13 Other Agency Operation Review _ a
— -
N
z
Routine OComplaint Q Follow-up of DW2 inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection a30 24 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified 13 Registered JE3 Not Operational Date Last Operated:
t County:..............!.�.... p`% I V1..................................................
Farm Name: .1E....L i T'.........
Owner Name:..........................................................
Phone No: ........... .
FacilitvContact: ............................................................Title:........................:........--............................. Phone No:......----........--...............................
Mailing Address: .................
..................................................................................................
Onsite Representative:.......:......................................-.................................. ...integrator:....-... VV-�................................................
Certified Operator:--.............................................................................................................. Operator Certification Number: ..........................................
Locaopn ofXarm: 1 � — r i I t S . 1 _ .1
. .-..L Q.`t............................................ .........................- ......................................................-.........................
Latitude �' �� Longitude
Design Current Design _.-. Current Design _ Current_ --
Swine Capacity Po ulation - _Poultry 'Capacity..,Po ulation Cattle` Capacity Population,'
❑ Wean to Feeder ❑ Layer - ❑Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder - ❑Other
ElFarrow to Finish
Total Design Capacity
❑ Gilts - _ -
El Boars _ = _ TotaI;SSLW ,..
Number of Lagoons. ❑Subsurface Drains Present, ❑Lagoon Area ©spray Field Area
Holdrn& onds / Solid Traps �_ ❑ No Liquid Waste Management System �#
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes W No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-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. Dees 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 b(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes X No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: o�
Freeboard (inches): �J I �� (� ..................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 19No
seepage, etc.)
3/23/99 Continued on back

. Facility Number: 3 — 6 ( 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
M 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
[XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
W No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
W No
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�UNo
11..Is there evidence over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
%No
Iof
12. Crop
type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
kNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
R[Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
MNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
[9 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[J'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
PqNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
DdNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ (No
22.
Fail to notify regional DWQ of emergency situations as required.by General Permit?
Yes
26 No
(ie/ discharge, freeboard problems, over application)
❑
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
ki No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
. ....
vi....... deficiencies mere nQfed . ..... .... . . . will receive no farther
rorresporidenke: ahauti this :visit.: - :::
Comments-(i•ef_er to questitin #) Explain aiiy YES answers andlor any recommendations-o :sny_other con
Use drawings.of facility to better explain situations. (use additinnal_pages as -necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number:3 — ( Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below K 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 ® 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 rurNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 9No
3/23199

0 Division of Soil and Water Conservation (] Other Agency
[A Division of Water Quality
1% Routine G Complaiut O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Inspection =15 24 hr.
Facility Number 1(t i
Time of (hh:mm)
© Registered Certified © Applied for Permit
10 Permitted
Date Last Operated:
[3 Not Operational I
Farm Name:............... ------�----Gro��.......... ------...----.....----.-------.---.-----........................
county:...... DRPAIKI......................................... .......................
Owner Name:.. ..........�x[.� y
.
Phone No: �� ZQ� ..� 5�' S `Ifc ...........................................
I................ I....................................................
FacilityContact :..............Sk.............. .Y.P.J.......................
Title:................................................................. Phone No:...................................................
Mailing Address: ............ 43`c.
.................. ...... :. i.i ... Q- i`° •
Onsite Representative: ...........
.. Integrator: ....... )`kyy. .........................................................
Certified Operator, ..................................................
.... Operator Certification Number:.------................
Location of Farm:
..... Dn..... t .......... ... a4....S ,...is ..Q,?s..'"" 5---..:_&: S.:.... .....!~:tZ.l. Q..x...........................•----.---..................................................I..---•-'
...................... ... .. ............. ..................................................... ............................................... .
Latitude a 6 it Longitude ' =1 "
Design Current
Design :Current , `Design `Current
v
Swine x Capacity Population,
r' Poultry
Capacity .Population Cattle Capacity lPopulatton
❑ Wean to Feeder
10 Layer
❑ Dairy
Ig Feeder to Finish
q
❑ Non -Layer
❑ Non -Dairy
C
❑ Farrow to Wean,
❑ Farrow to Feeder
❑Other
m
❑Farrow to Finish
yTotal Design Capacity,'.
❑ Gilts
❑Boars
r Total`SSLW'
:
Number of Lagoons I Holding Ponds
Subsurface Drains Present JNFLagoonArea
RsprayFieldAreKE
h ID No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
II 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 Surface Water? (If yes, notify DWQ)
❑ Yes
JP No
c. If discharge is observed, what is the estimated flow in gal/min?
l�1
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
�3 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
(P No
7/25/97
Continued on back

Facility Number: —1
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoon~-Ilolding Ponds, Flush fits, eta
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I z .............................................................. ............................. .. .. ...I...........................I............................ 'r
Freeboard (ft):...........z-.............................. - 2............... 2' `i
............................... ......................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers"
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15 Crop type bMVIOJO, st 11 -1.k,
El Yes P No
El Yes. PNo
Structure 6
... ..................................
........................................
❑ Yes No
❑ Yes [� No
Yes ❑ No
ElYes No
ElYes No
......................................... ................................ ............. I ........ .....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW;MP)? ❑ Yes iO No
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 reviewtinspection 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 AWNIP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or d'iciencies.were-noted during this.visit.- You.w_ ill receive no further .
. �. � correspondence ab"vut this�.visit:, - � :.. :: :. . � . � � : , .. � : � : : - - - : � : � . • , . � : � :: � :.
❑ Yes No
❑ Yes } No
❑ Yes No
❑ Yes (�, No
❑ Yes No
%Yes ❑ No
❑ Yes allo
cn
Yes ❑ No
Yes ❑ No
)111
Cornments;{refer to- question #): Explain any I -ES answers andlor any i&6'n' mendattons or any other cointnents k' 4
Use drawings of facility to bitter tiplain situations {.use additional pages as. necessary} k
.
s: - sTcK Low t 5 .i,\ � ,, s al s s�� d be_ 41
Z w a�c�.s vr• All o' tJr (a ear. ; I(e Gay11s-,6-jJ6 Joe- rtA ". PA v%or erosb,\
Gv� oh tAMA,1 r}\�R 0� (&)OOrl rnlid\or C"S D1\ OV, OAr a!V-L a� la)O' _�_- 3 sk",)1C1 10.
hJf
rvc--e44 • f5VACe 56113 6e~ wkovt6 e-K of (6,500v. -4:1't. 00
Y tl\_i V\Oy 0~4,W { C &b O r. o �- vK �Y oyc� L LS l bs a c 7/25/97
-
Reviewer/Ins ector :Fame
Reviewer/Inspector Signature: _ Date: &

JOLRoutine OCam ptaint OFollow-uEof DWQ inspection 0 Follow-up of DSWC review 00ther
Date of Inspection
Facility Number 3 I me of Inspection 24 hr. (hh: mm)
Total Time (in fraction of hours
[:1 Registered D Applied for Permit (ex-.115 for 1 hr 15 min)) Spent on Review
Farm Status: 99 Certified 0 Permitted or Inspection (includes travel and processing)
[3 Not Operational Date Last Operated: . .....
Farm Name: .....
County:_[).W.4 � -r
Land Owner Name: - --- - ---- . ......
Phone No:—L
. __r
Facility Conetact: . ..... . . ..... . ..... . . ..... —.- Title:
Phone No; . ......
Mailing Address:
Onsite Representative: Integrator:
Certified Operator- .. . ..... ... k Operator Certification Number:
Location of Farm:
_9 ... . . .... ----------- - ------------- . .....
Latitude Longitude • 6 4�
Type of Operation and Design Capacity
DesignQM
jAU r Dgn Current A
...... ... .... .
na H
ateodln
A 0 Wean to Feeder La:yeff
Layer Non -Dairy
Feeder to Finish -3 -z-
Non-
Farrow to Wean
c a
W, _07
0
a
'M Farrow to Feeder w
MEN!
0 Farrow to Finish
-.0
", OW
IS
R.
TWO
e - Is Lagoons-
u IgSubsurface Drains Present
IN,
;W
74- Ill Lagoon Area j Z j&7Spray Field AreaT,;,.
E-::
Qenerja
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at. [I Lagoon [I Spray field [I 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 gal/inin?
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?
[I Yes JRNo
[I Yes 0 No
[:]Yes El No
[I Yes 0 No
0 Yes
ONo
0 Yes
No
0 Yes
No
J&Yes
0 No
Continued
on back

Facility Number: ... al_ —._16 ]....
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 19 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lag_ o�and/or,Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
❑ Yes Jallo
❑ Yes jgNo
❑ Yes jS No
Structure 5 Structure 6
❑ Yes 21 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
jffNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
jKNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type - --- --- u> ...... S�rUa.c�11. ....... ..........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
to No
18.
Does the receiving crop need improvement?
®.Yes
❑ No
19,
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss revicw/inspection with on -site representative?
❑ Yes
j No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
&No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
&No
24.
Does record keeping need improvement?
KI Yes
j] No
Compents (refer to questioA'#} Explain any YES answers; and/or nny recommendations or any other cainrrients .
Use diawingsof facility to better explain situations`(use-additional pages as nec/essatry/) _ <
c,
cc Y Y e. c t b C"- - d- V_t.- t' Y�'E�Q fi �+�iti"S .�, 5 p'rn'Y7 �-LL4 • �V f ✓� N C`.++V i V tNl
12. R e v t3 @- t wi �- d! 1 b wVly� tx Y e u-i o ,.. J 0 0 �n t� t[ l v. fa-" I r 0 h�
c o r ,r v t f -a S i o •, S t -o r
18 . C_.o Y- v" e_c A W e e4-- ''b b i Q•ti- 1 CO C, S t+ t
j
Csrk- iVrrti,,%.L So,1 savv��le-S. Pvt �1ra�l b1 berw,Vdo� i,.�td P!
t � i 2, k-etS -aL e- 4 V
Reviewer/inspector Name N
Reviewer/Inspector Signature: Date: JI �1
re: Division of Water Quality, Water Qualiry Section. Facility Assessment Oil 4/30/97

'a
•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT /
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z' C3 , 1995
Farm Name/Owner:
Mailing Address:
County:
Integrator: �,� „ d c#/ _ Phone:
G r ��
On Site Representative: _ �T�� ��e���,�Y6�0/�=, Phone:
Physical Address/Location:��0 R _
Type of Operation: Swine '1/ Poultry - Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° d2 Longitude: ' 0 Elevation: Feet
Circle es . r No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: 2__Ft. Z, Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or vid
Is adequate land available for spray?
Crop(s) being utilized: dC
No Is the cover crop adequate? Y0se or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or io
100 Feet from Wells? Yes ore
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?. Yes or(S�>
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orco)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or il� o 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)? eesDr No
Additional Comments:
0
Inspector Name
Signature
cc: Facility Assessment Unit Use AtEachments if Needed.