310783_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

' � ivi"lion of Ws`ter Resources , r
Facility Number 3 - "7 0 Division of Soil and Water Conservation '`
O Other Age�nc•y
Type of Visit: Compliance Inspect€on Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other
0 Denied Access
Date of Visit: Arrival Time: L_LtL`�� Departure Time: 1 County: r���' Region:
Farm Name: 4�1 061- v-� Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
a
Certified Operator:
AIAXA
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: ISI LQ.Z
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish ppNon--Layer
Design Carrent Design Current
Wet Poultry Capacity Pop. Cattle C►►opacity Pop.
r DairyCow
Wean to Feeder
9 p
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D Cow
ry
cker
Farrow to Feeder
Farrow to Finish
Layers
Dr, l;oultr, C+_a aci P,o ,LBeefFeeder
Gilts
Non -Layers
Boars
Pullets
Turkeys
Turkey Poults
Other
ood•Cow
Qther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [�`No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes n No
❑ Yes tf No
❑NA ❑NE
❑NA ONE
[a NA ❑NE
Page 1 of 3 21412015 Continued

acili Number: - Date of inspection: l t I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 11L 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2j-o 2-3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes j,"2q No ❑ NA ONE
❑ Yes 14 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes] 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 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes 9No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking PO Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

IraclWy Number: - i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ONE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes 6 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Corn�tteirts(refer.�tom uestivn #,)�Ez 7itin a`n`,YES:iiriswers�andloi'-itir`rad'ditionalrecominendationsror an aoth,er corn`nents". tffi
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone;
Date:
/4/2 I S

Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: "7 Arrival Time: 1po Departure Time: County: 4 / Region:
Farm Name:��/r��~ �j Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Phone:
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P■oultr,ea aci P.oP.
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
HTurkey
urke s
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 ❑"No [DNA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes [;ErNo
❑Yes fN0
o
❑ Yes
[DNA ❑NE
❑ NA ❑ NE
[3 NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J�j No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes La -No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-V
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 '12-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 f 2,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 �F ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /015o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes LQ.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Z,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes -ffl—No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E2�-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes allo
❑ 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 jErNo
❑ 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 4
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes _[2fii"o
❑ NA
❑ NE
Page 2 of 3 4 21412015 Continued

]Facility Number: - Date of Inspection: / 11 L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [/] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E:�FDdo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �' o ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes C2 No
❑ Yes [a -No
❑ Yes ❑0111
'3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes 2r10 ❑ NA ❑ NE
❑ Yes FNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Comtuents (refer to g6estiorr#,)`rExplain'anyxYES answeri and/or,:eny?additional;recoininend'a'tioFns or"any,�otlier comments;y Y ? :r
Use drawiti' S of"factl�t4 toBbetterexlain situations 3 iise addit�onala'v a� es asFnece`ssa . t':: ` { ` = k `..�'
g t_... Y, ..l?.. (, P_g._ rY}--.�t r,
e- rCC frC1f loak'_� o v
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
L !�
Phone:'& 7'76�?32_
Date: L C
21412015

Type of Visit: 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Q� Region: _
Farm Name: S a� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
or
Certification Number:
Certification -Number:
Longitude:
Design Current
Swine Capacity Pop.
Design
Wet Poultry Capacity
Current Design Current
Pap. Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
airy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design
D . P,oultr, C•.a aeit
Current Dry Cow
Pao P. Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers.
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 2no ❑ NA ❑ NE
❑ Yes .,n 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)
❑ Yes
ONo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
�No
7E;Mo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of lns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2fNo
a. If yes, is waste level into the structural freeboard? ❑ Yes f:fNo
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Observed Freeboard (in): & _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
waste management or closure plan?
❑ NE
❑ Yes
❑7"No
❑ NA
❑ Yes
LD�No
❑ NA
❑ NE
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?
0 Yes ;No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 2�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require 0 Yes /En —No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [D.;�o
❑ NA
❑ NE
maintenance or improvement?.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2'&o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
:jAo
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
©Tlo
❑ NA
❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable
❑ Yes
J:�,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B No
❑ NA
❑ NE
Required Records & Documents 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 ali components of the CAWMP readily available? if yes, check
❑ Yes
Q'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L�'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
J.No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain raiiinnbreakers on irrigation equipment?
0 Yes
�No
❑ NA
❑ NE
Page 2 of 3 . lqf yf 'It- %Cal-01
e jovolr
21412015 Continued
%!Gd
�%

Type of Visit: ompliance Inspection 0 Operation Review • O Structure Evaluation Q Technical Assistance
Reason for Visit: 911outine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: -yp Arrival Time: r, 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:
Latitude:
Phone:
Integrator: /7-L
Certification Number:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry C►apacity Pop. Cattle Capacity Pop.
Finish
La er
Non -La er
Dairy Cow
Feeder
Dairy Calf
o Finish
o Wean
VFao Feeder
Design Current
D , P,oultr. Ca aci P,o .
DairyHeifer
D Cow
Non-Daio
Finish
Layers
Beef Stocker
Its
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [/No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 2j 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 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 )21 No
❑ Yes C� No
[—]Yes d No
❑NA [3 NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste C_ollegtion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes �No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a C/
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ 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, etd.)
❑ 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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
( No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
NA
❑ NE
Required Records & Documents
T
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
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? []Yes �'� No
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 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes PrNo
25, is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes VNo
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes; contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
pen -nit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No
❑ Yes /'No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 'ffNo ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes n/ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 4! No ❑ NA [] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Z o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes WNo ❑ 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).
��qrm /"e- COMA &vim _ Oca,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone;��(/��/
Date: Z
2/4/ 011

Type of Visit: O Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: eparture Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: :1 S21 rCl1A r—i
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: ✓l'L Z
Certification Number:
Certification Number:
Longitude:
Design
C �rrent
Design
Current
Design Current
Swine
Capacity
Pop.
Wct Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
1)r. P,oults
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Impact
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 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 2/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] o
❑ Yes o
[:]Yes �No
[] NA [] NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number j I- Date of Inspection:
Waste itollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es ❑ 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: �' 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %D_
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 environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? [] Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNgo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C�f'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 [ 3/N0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EKO ❑ 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 ❑ No ❑ NA Zl�f
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA L✓J NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA U4E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA L.d'1"E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No ❑ NA
Page 2 of 3 21412011 Continued

Facility Number: - 7AT Date of inspection:
24. DLl the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ No ❑ NA E
WNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, frecboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes Q No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes Er VNoO
NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes VNo
� ❑ NA
❑ Y ❑ NA
Yes ❑ No ❑ NA
(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).
❑ NE
❑ NE
❑ NE
RA, S cojr '7/tij3, ESL 2►v�x.7 G- L.oI�/E� W4 G-o� ni
7 Ar LAT tzp � . ?�� r3 , � f `� 9vJQ
B 6PJD OF llfl)3 OF, 1'e" Vey
Y i V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: J A
Date:
21412011

Type of Visit.,0'6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,,�<Outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: e Q Departure Time: County: 4 ck&= Region: 1!A Z &..
Owner Email:
Phone:
Physical Address: `
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: /,Opt/,^
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ; = Longitude: = e = ,
Design Current
Swfne Capacity copulation
Wet Poultry
Design Current Design Current
Capacity Population C►attle C►apacity Population
1 ❑ Dairy Cow
❑ Wean to Finish
❑ Layer I
❑ Wean to Feeder
10 Non -Layer I
I ❑ Daia Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Other
Dry Poultry
❑ Layers
❑ Non -Layers
ElPullets
❑ElBeef
Turkeys
FP —Turk Poults
❑Other
Brood Cow
Number of Structures:
❑ Other
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 ;M ❑ NA ❑ NE
❑ Yes XTNo
❑ NA
❑ NE
❑ Yes ,DNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ YesoENo
❑ Yes ?TNo
❑ NA
❑ NE
❑ Yes O/No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: t - Date of Inspection:
y
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):
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of of��an"y�o��f 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 ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ 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 ,e+No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;:�No
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �LNo
❑ 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 �j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes G No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E�r No
❑ 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 [:�,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yese-E5"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,E!rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes / No ❑ NA [] NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: ieZ2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P�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 ,E:f No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes El"No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Yes ,❑i'Ro ❑ NA ❑ NE
❑ Yes J ' o [DNA ❑ NE
❑ Yes 2T No [] NA ❑ NE
❑ Yes ;allo ❑ NA ❑ NE
❑ Yes 21rNo ❑ NA ❑ NE
❑ Yes 12-No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or anyadditlonal recommenuations;or; any.
Use drawines of
Y// 71177
ty to better
Reviewer/Inspector Name:
. 3 ,-
0, 7 s
o , -7 .%-
V• S­0
situations (use additional pages as necessary)
01 L/ S
Reviewer/Inspector Signature:
Page 3 of 3
OL C_C'v.'
"t--s V
comments,
r -'-� V- r2 C-C" r V-60- j� Lod l5- 5o v& l
Phone: 7
Date: / 2
2141241

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: _ 2.z /, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
�Onsite Representative: 6 '.Z62ez..4//
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: _/-K /z6_
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 6 Longitude: = o 0 , "
Design Current Design Current
Swine Capacity Population Wct Poultry Capacity Population Cattle
Design Current
Capacity Population
❑ Wean to Finish
❑ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
I JEI Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑Non -Layers
El Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dry Cow
ElNon-Dairy
Stocker
El Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Farrow to Feeder
El Farrow to FinishBeef
❑Gilts
❑ Boars
the
❑ Other
Discharges & Stream Impacts
. 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 j2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ErNo
❑ Yes
21"No
❑ NA
❑ NE
❑ Yes
P<O
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
•4. Is siorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,ZNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑,�No
El NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ONo
❑NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ;a No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
❑ NA ❑ NE
maintenance or improvement?
JFeNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes -ZNo
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ZrNo
❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
4No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to gi�est�on,#) Explaan,any YES answers and/or, any,recommendahons,or any othencomments ` r*,1 P, ,
awoffciiytobterxpainsuaonsttse�aidtioapsary).eill
Use dr1ge
Name
Reviewer/Ins ector
p Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rJ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3'Tlo []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 M No ❑ NA ❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑'(\To ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;2"No ❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes O'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9lo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
51'No
❑ NA
❑ NE
Other Issues
28.
Were any, additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.l�
9111
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I 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
;?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
❑ Yes
jZfNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EfNo
❑ NA
❑ NE
Page 3 of 3 12a8/04

Type of Visit 0 mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit_,C�Aoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Ar ival Time: s Departure Time: County: Region:�a
It
Farm Name:�10Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = =16 Longitude: = ° ❑ ` = «
Swine
Design Current
Gapaacity Pup�ulation Wet Poultry
Design Current Design C►urrent
C►apacity Population Wtle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
-Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑Non
❑ Layers
-Dairy
❑ Beef Stocker
❑ Farrow to Finish
Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
ther
Gilts
Beef Feeder
poBoars
Other
❑ Beef Brood Cow
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes P"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
N+ o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,❑l
,LEI No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑No
El NA
El NE
other than from a discharge?
/
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 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ YesZNo ❑ NA ❑ NE
StrLMture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4�
5. Are there any immediate thread the integrity of any of the structures observed? ❑ Yes (ErNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes O 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? ❑ Ycs
❑ NA ❑ NE
,�no
8. Do any of the stuctures 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 LQ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Vo
ElNA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Veo
❑ 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
�Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[j.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
D/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2"NO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4Jeo
❑ NA
❑ NE
'Cv.mments,{rto question #): Explain any i�ES 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 / ;' _. ; ., " € " `v r Phone:
Reviewer/Inspector Signature: Date:
pnvn :) fif 1 12128104t Continued

UT
Facility Number: — Date of Inspection
Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ?'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z_No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Plo ❑ 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 ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�Ko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
jNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PlolVo
❑ 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?
❑ Yes
O<o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�2 o
❑ 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
P?No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2 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
ZfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JZNo
❑ NA
❑ NE
,•�.�
/ro"r Dr�gwings:
A`dditiqu"al�Coroments andAL
p.
C rkr'/i
0 � t'I
Page 3 of 3 12128104

!W
Dw�as�on of Water Quality
Faculty°Number �pj� YO'Divtsioit of Soil and Water Conservation
— Q Other;Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
It I
Date of Visit: D Arrival Time: �/ rf Departure Time: County: — Region: �%l'O
Farm Name: T Z— Af4f f�1F rYl 2 � OTw'ner Email:
�r
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:11i
Certified Operator:
Phone No:
ZO
Integrator•
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: ❑ o ❑ . ❑ Longitude: ❑ ° = 6 ❑ «
Design Current` : Design Current.. Design Current
Swine: Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder 15?i01-53
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
III Boars _ Ij'
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
0—Turkeys
❑ TurkeyPouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Dairy Cow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CovJ
Number of Structures:: Fz
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
❑No
❑ Yes /No ❑ NA ❑ NE
❑ Yes Elm) ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: Ak A)o
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 'ZNo ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
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? El Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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) / C . —.5, e
13.
Soil type(s) _ _- �P / A 6
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
/0
❑ Yes No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
f
❑ Yes JLI No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations, or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary);
is 00 L71nl, /�S 0 67sXo Zit/ � ii D4v
Reviewer/Inspector Name _ �� I Phone: 9119—
Reviewer/Inspector Signature: Date: T Q
Page 2 of 3 12128104 Continued

1
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes oNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 10NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [INA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes VVo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ONA ❑ NE
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?
Comments and/or Drawings:
❑ Yes P No ❑ NA ❑ NE
❑ Yes �No
❑ NA ❑ NE
❑ YesXNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 1�<&mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G-Ko-utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L2
�
Farm Name: �_
Owner Name: r
Mailing Address:
Physical Address:
Time: 16•'00 1 Departure Time: County:
Facility Contact: Title:
r
Onsite Representative: 'aim( J
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Owner Email:
Phone:
Phone No..
Integrator: r
Operator Certification Nu r:
Back-up Certification Number:
Region: Llr n
Latitude: = c = I ❑ « Longitude: 0 0 = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer II
00 on-Layet
Other
❑ Other I- - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daity Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: �!
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
❑No
❑NA
El NE
El Yes
❑No
❑NA
❑NE
12128104 Continued

Facility'Number: — Date of Inspection 1. O,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes �' o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 'p Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers El Annual Certification
❑ Rainfall ❑ Stocking J[J Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J:�']Qo ❑ NA ❑ NE
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?
L
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
❑ No
12 NA
❑ NE
❑ Yes
❑ No
;'NA
❑ NE
❑ Yes
❑ No
0,1VA
❑ NE
❑ Yes ;20�o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA�lE
❑ Yes
O'go
❑ NA
❑ NE
❑ Yes
tP�No
❑ NA
❑ NE
❑ Yes PIKo
❑ NA
❑ NE
❑ Yes X0
❑ NA
❑ NE
❑ Yes
❑ NA
LINE
❑ Yes Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:
e�l cry k jelds a►A aP6x0U
�e�ar�S
12128104

Facility Number: 31— 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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:.-�
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
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 WNo ❑ 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 'PiNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes ((No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
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. ❑ Yes ''No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or'] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) • 0/�?11190 T1C, / t'14/l- " �76�-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P fo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
Vo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Reviewer/Inspector Name Cp 4_' "'°°`.!CrxFs�- I¢ Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

(Type of Visit OCompiiance Inspection O Operation Review O Lagoon Evaluation �
Reason for Visit 04outine O Complaint O Follow up O Emergency Notification O, Other ❑Denied Access
Date of Visit: %4 % U Time:
Facility Number
O Not Operations! O Bel
© Permitted [3 Certified Conditionally qertifled © Registered Date Last Operated or Above Threshold: .... _._.. _.. _.
Farm Name; .....County:...f_?............_. _ ._._.__...._
Owner Name: -----__-_-- -------------------- —-------- ------- - Phone No:
.Mailing Address: .» . »._ .....».......» . ... - - _ ...».. »...... .»»...». . » .._.......»» . » _. _ . ».....»....»....... »... » ...
Facility Contact: .w_ tle:._ . __ __._ _ _ _» Phone No:
Onsite Representative:..., f�, ....r(J .--.,�.� .,. Integrator: �.,lrj,e�
Certified Operator:.............................. ,„_._..... �__...._....._.................__ .._..._. Operator Certification Number:._.... .._.... .. _._.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes 21q0
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 .0 N'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes .E114o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 13140
�vWture I � S�ture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection
5.,,Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
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 maintenancehimprovement?
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? If yes, check the appropriate box below.
❑ Excessh
12. Crop type
13. Do the recei,
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?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ,.❑'90
❑ Yes,b'No
❑ Yes rN�o
❑ Yes Z tvo
❑ Yes 0 No
❑ Yes '0 90
❑ Yes ❑ I�io
G
❑ Yes ZNo
❑ Yes EJ'No
❑ Yes ,ej"No
❑ Yes Ef No
❑ Yes C No
❑ Yes J! N�o
❑ Yes P] No
❑ Yes ❑-No
❑ Yes ONO
❑ Yes ❑140
Field Conv ❑ Final Notes
COW
l
y
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 10115Vel
12112103 Continued

Facility Number: 3 / — Date of Inspection
Ri'guired Records_& DocnmenN
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes f:rNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes �Ogo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IVO'go
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes -Emo
25. Did the facility fail to have a accdvely certified operator in charge? p Yes 0,90
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes OVo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes -E No
28. Does facility require a follow-up visit by same agency? ❑ Yes -ENo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �2FNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) [:]Yes 0-14ro
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

ti,
Facility Number
Date of Visit: Time:
MotOn,ratlonal Q Below Threshold
Permitted 0 Certified �J0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Z!F/Z&- (-/��� )Fg✓MM ,' '? f,— County:
Owner Name: � J4'77es , 5^T/Odalo Tr' Phone No:
Mailing Address:
Facility Contact: ''�� Title: Phone No:
Onsite Representative: //! 'V.'- Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 Dµ Longitude 0 4
Design
Current Design Current
Design Current
S.wIne Ca set
1'o ulRion P,oultr. Ca aci , Po ulatian Cattle
Ca act P.o Watian
to Feeder
10
La er
1
11 JEJ Dairy
rWean
❑ Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Nurstber of Lagoons
❑ Subsurface Drains Present 7110 Lagoon Area
Spray Field Area
Holding Ponds l Solid Traps 0 ❑ No Li uid Waste Mana ement S stem
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 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: ! -2—
Freeboard (inches): M ~ Z$;�4f
❑ Yes J�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E.No
❑ Yes iR No
❑ Yes J,No
Structure 6
05103101 Continued

Facility Number: ' — ;;93 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Analication
❑ Yes 'j No
ElYes =[No
❑ Yes CKNo
❑ Yes R No
❑ Yes � No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
F[ No
11.
is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
qNo
12.
Crop type ✓/!1 ✓GLL{ � d' (� ,�r�e��L 4�rit
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
'O No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
RNo
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
M No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
W1 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[5� No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes CO No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
`Gomment`s?(Fefer to question #). Explain an ;:YES'answers, nd/ar any recommendations o aay'ot er comments � "' 'k
Y.
Use drawingsroffacilityto tictter ezplaln situatrans. (use additional pages as neces9ary) El Feld Copy El Final Notes
s
v Y:. t b E+ i'
Vo% e; 1h5fe!a� a Cu7 ( 11,17resvh 7� 5�Ae­-d71e 41— 'eeeGr
�'e3 tr�fS h e tW -710 �/.- �o�4�i'P� a- e011 I eeor -/I 1�D Q464
re Ord 4 Gd�t�t 5��1��� 7�4n
7
Reviewer/Inspector Name
Reviewer/Inspector Signature: 6 Date:
05103101 l y
Continued

Facility Number: 3� — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XrNo
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 21No
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 [�FNo
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 R No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes allo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 11KNo
5100

p
3 �P -A
t qfi Divtston of Water Quality ' e
{ Q Dir—ston of Sail'andEWater Conservation €_
{ € t i Agency t I ��� !
OSi
Oder
Type of Visit Orcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .Qf Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: %2 / O Time: % Q Printed on: 7/21/2000
10 Not Operational C Below Threshold
J6 Permitted E3 Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
f O�iP l-2ME "2 'd� County• �/ eq
FarmName. .. ...................I......................... .............. �rK.t. ...... ...............I............... ............................................................
Owner Name ,. .......................�� ,QQ�/. o............ Phone No:
.................................. .............
FacilityContact: ............................. ................................................. Title:.:.............................................................. Phone No:...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative:fjf-.......................................... Integrator:.,'fi //f�
Certified Operator:,,,,,,,.,,.
Location of Farm:
Operator Certification Number
Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude
Longitude • 4 �«
Design ' Current
Design
Current Design CnrireiAt
h,.,..... e.. --.`.. :..::. .`'Ctti acf :Po tilation,
Poultry Ca aci
Population Cattle Ca` d -'.Po ulation
Wean to Feeder / Q
❑Layer
❑Dairy
Feeder to Finish
❑Nan -Layer
❑Non -Dairy
= Farrow to Wean
"
Farrow to Feeder
❑Other
Farrow to Finish
Total Design Capacity
Gilts
JMV Boars
Tota1SSLW
Itder o[Lagoolns i! '
im
❑Subsurface Drains Present ❑ Lag -on Area ❑Spray Field Area
€ g>!iolding I'onils / Solyd Traps
€ ,•S2x."€,;.^.c „_,eaa [ rid al .e .Ite. ..r„ .,i ...i•
,.
❑ No Liquid Waste Management System
.. ,..•: -.r � ,-x .., e
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`?
b. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallrnin?
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
ilture I SVucturc 2 Structure 3 Structure 4 Structure 5
[�Identifier: ............................ -.2 .......................................................................................................................
Freeboard (inches): 7 V/ �' g
5100
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 09No
❑ Yes PINO
r
❑ Yes 00
Structure 6
Continued on back

*p - w
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes allo
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? ❑ 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 VfNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9No
11. Is there evidence of over application? ❑ Excessive Ponding ❑%PAN ❑ Hydraulic Overload ❑ Yes [jNo
12. Crop type �,� (1f1 7i,��i / S. C-, Aed 5z7 ZZ9
13. Do the receiving crops differ with those designated in t1'ie Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
. y p�i¢tas'o� dgfc�ea�ie$ wireit�rr°...... �. .... ..wi.fe ....r
. • . • corresaoridence: about this 'visit: • ............................ .
❑ Yes 0 No
❑ Yes dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes [ No
[]Yes F(No
❑ Yes X
No
Yes I
❑ Yes I
❑ Yes No
❑ Yes No
❑ Yes Z"(No
No
Yes
❑ Yes No

r! f 1 _''II ! ! ^, I' tI ° i -;i A .' �I•OfWater + ' r.
❑tVlslon QUallty
O Ptv,s�on of Soil and Water. Conservation
r I. -I- IIltr M I: MJa F s y.
I u i- ! F I n"d ; I�
t.-A4 Ll c
......?k1.Y
Type of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit lI Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: `2 -00 'lime: � Printed on: 7/21/2000
Q Not O erational Q Below Threshold
Permitted [3 Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: ....... e�A„t(...... .............. County:....H!.1'............................. ..... .......................
Owner Name:....... Q! !!icr5 .............?ti.LT .......r.............................. ........... Phone No: ...... .I.�. ........................
FacilityContact: .............................................................................. Title:................................................................ Phone No:..........:........................................
MailingAddress : ............................................. ....................................... ........................................................................ ........................... ............ yy ..........................
OnsiteRepresentative:........................................................................................................... Integrator:........... lJr�n..................................................
Certified Operator........ A,m.iG�..............3 .. sq-IQU.Q,. 3.r...... Operator Certification Number:.................
Location of Farm:
Swine ❑ Pouttry ❑ Cattle ❑ Horse Latitude �* �' ��� Longitude �• �° �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish J❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons �
Holding Ponds / Solid Traps
10 Subsurface Drains Present ❑ L-' � n Area.
10 Spray Field Area
I0 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
,jNo
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑Yes
ER No
c. II' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Wo
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
[1I0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
;RNo
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
eNo
2 Struc;ture I %t36t1'ucture 2 Structure 3 Structure 4 Structurc S
Structure 6
Idcntifiex:.............�.q............ .............. -40........ ...I.............. ...........
.............................
Freeboard (inches):
5100
Continued
on back

Facility Number: 51 — 7 Date of Inspection -Z -d Printed on: 7/21/2000
5. Are`therd'any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Mio
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? ❑ Yes 4NO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes j(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 04sTo
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)?
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?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
{'Vo yiolaiitils;o;r defcier�cies : Yoix will ree�iye �iq further; ;
coraris06iideii ' e' ab' * t. tH visit.. ;
Comments (refer to.question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name
Reviewer/Inspector Signature:
❑ Yes E*o
❑ Yes EWNo
❑ Yes 4No
❑ Yes ❑ No
❑ Yes 1XNo
❑ Yes t) No
❑ Yes kNo
❑ Yes � No
❑ Yes 'o No
❑ Yes 1� No
❑ Yes [S(No
❑ Yes] No
❑ Yes[` No
❑ Yes �No
❑ Yes VNo
1�
Date: %d - z 7 005/00

Facility Number:e — Date of Inspection - 7-0Printed on: 7/21/2000
Odor'Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
0 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
0 No
roads, building structure, and/or public property)
29:
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[No
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
VNo
31,
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
rM No
1(g'No
32,
Do the flush tanks lack a submerged fill pipe or a pe�manent/temporary cover?
❑ Yes
S/00

f ' 0 Division of Soil and Water, Co
�' [3 Division of Soil f ndl Water Co
M ivision of Water', u liiy -,G
0 Other Agency -Operation Re,
vation Operation Review
valt>toni ° 'Coainpl>Ii— ,Inspection
3 I, a
Bence Inspecdan E �.
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspectiou K�in24 hr. (hh:mm)
C3 Permitted 91 Certified ❑ Conditionally Certified [3Registered JE3NotOperational )Date Last Operated:
Farm Name: ...../``!I�G. .... ,l1'�'�4-.... 1 .. # ................................. County:.....,..../.. .....11:1'�.................................................
OwnerName:........... ............... >:.? Y4.PL Phone No:..........................................................,...
Facility Contact: ....... ............... 7Q .....Title:.... -Wmr................................. Phone No:...................................................
Mailing Address: �S ....?......?ClTYLK ... /� A�hl1 i!l.i..r ,.,.11<..,.....'L.....
.. ..... ........................... .... V
Onsite Representative:—..�le.5.................. `7�id.4. Integrator:............J.vC....................... ...................................
Certified Operator:..... ,,, ,1,x............................................. Operator Certification Number:..........................................
Location of Farm:
................................................. ...... ......
Latitude Longitude 0 • �� ���
Design Current Design Current Design Current
SPotwine ' - CCapacity acit oi iildt�on Cate Po ulatioyn'z
;
Wean to Feeder
2
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
fElLayer ❑ Dairy
Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
'Total SSLW
yiNutnber of,Lagaon$„ - ❑ Subsurface Drains Present ❑ Lagoon Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
�.
❑ Spray Field Area
3
Discharges & Stream Impacts
I. 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
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes j No
c. If discharge is observed, what is the estimated flow in gal/min?
44
d. Does discharge bypass a lagoon s~tern? (If yes, notify DW )
❑ Y4
k No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: '9111er' 6'1e16Xz- od r- 6eek*3
Freeboard(inches): ........�............................z�.......... ........... ... ...................... ................. .................. ...................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes �No
seepage, etc.)
3/23/99
Continued on back

Facirity Number.,'-3 — qg3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenatice/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 Po�nndiin ❑ P
12. Crop type
13. Do the receiving crops differ with those designated in Ce4ified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation; freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with.any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection 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? .
10 vielal~icjris:o:r dg#iciencies ogre n tecl dpt ing th is'' . Moir ... recgiye ti iurt fir. .
.. .....
corr46ii #e' ce. abi ' this .visit.
[—]Yes �No
❑ Yes No
❑ Yes o
❑ Yes gNo
❑ Yes FNo
❑ Yes $ No
❑ Yes R<No
❑ Yes ❑ No
❑ Yes ❑ No
/9 Yes ❑ No
❑ Yes KNo
❑ Yes YNo
❑ Yes OLNo
❑ Yes 9No
Al Yes ❑ No
❑ Yes 0 No
❑ Yes � No
❑ Yes &No
❑ Yes kNo
❑ Yes gNo
❑ Yes [, rNo
Comments-(refer,to question #I')t Explain any YES,answers'and/or any recommendations or-anytother comments �q n t'
Use drawing of facility to better explain=situations {use additional pages as necessary)
/9 dR ,SD�1 1Nvr� AL
47vtly6i� 4KAJ do`s ok
Reviewer/Inspector Name
Reviewer/Inspectoe Signature: Date:
3/23/99

Facility Number: r7RJ Date of luspection
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
I No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
V 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
jZ No
32.
Do the flush tanks lack a submerged fill pipe -or a permanent/temporary cover?
❑ Yes
� No
3123/99

13 Division of Soi! and Wateit6'servation' Oper'anon Review '' " r q girl
E.Division (if Soil and Water,Conservatroin' Compliance `Lnspectron a i F
r �< 01 s n
Division of Water!Quahty -Compliance JCnspecilon ` ` S° r i , ,iY , F ri ` F p
r
i Other Agency,; `Operaho�i'Revtew:.,. * '
O Routines 0 Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review M Other
Facility Number 3 Date of Inspection J
--- --- - __ Time of Inspection 24 hr. (hh:mm)
© Permitted Ep Certified (3 Conditionally
�
onditiioonally Certified [3 Registered E3 Not O erational Date Last Operated: ..........................
Farm Name: ............oi) .....C1 1;;xg1........kt- .. ... ��............................ County:........ 3.l.!'1...........................................................
Owner Name: ...... ..!?A.MIrS..........................T.f.�ktd.,.....re.................................... Phone No: `;1 �.!�.....Zr..4.... 15................................,
Facility Contact: .............................................................................. Title: Phone No
MailingAddress:l!�..... l.0.v ......................................................... ..1:.1lai.;....k!t...................... ......,...,.,...,...,...,..��y�........
Onsite Representative: �.t.... �. ... Integrator: ......... Ktl�.......................................................
Certified Operator. Jp+ � J [�, '�,(,j,,,,,,,,,,,,,,,•,,,, Operator Certification Number.�,D`, Z
Location of Farm:
ih...... W& %td.gr.......4............5........I.`1a..�..D.re..x'`.1. 1e... ..... i..•....7�lCS.... oO.
?...f !.�i�ti.. 1��.......................................... .....
Latitude r—W`
Design Current.
Swine, CaDacity Ponulatinn
Wean to Feeder
-Lop
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Longitude ©• ��«
Desrgn Curretit Design Current
Poultry Capacity Population Cattle -Capacity Population I `
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
3 �1P li lla'�fil f,F ti I iI
Total Design Capacity w'
ih
Total SSLW S(, 0 00
r Number of Lagoons � a k ; ❑Subsurface Drains Present ❑Lagoon Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impactti
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. Docs discharge bypass a lagoon system? (If ycs, notify DWQ)
Spray Field Area
i
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
Identifier:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard(inches): ............ 5................. .............:........ ............................ ...........................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
3123/99 Continued on back

•• Facility Number: Bate of lospection
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents.
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�'Vo violafiQt�s.. cl.i.... i.. mere pQtec3 daring •thls'ASI ; • Y:oir Will feboive 06 furthor . .
�corr�s� oridehc'e'. about; this :visit. ......................... .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes [:]No
❑ Yes ❑ No
❑ Yes [:]No.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes ❑ No
[-]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
wmments krerer to quesuon ftl., r xptam,any•Y ra,answers anauor`any recommenaattons o ,anyjomer comments ; -' E _ F�
g. Y
Use; better explain situations., (use additional, pages as necessary).,
a drawin s of facility Ea.A
A.
iAsPtc ar. rtsps,�se 4o A-,I.k111 +hve5OA. No �YbWkym c6vve), Nor Sro�
ec Reviewer/Insptor Name
i B t
� d;. 3 Y.+3'kl,.'•'�`� S + °. ;� a aII ,t & II 1. _` S �t �ii "i;
.., �. � [ ♦ . 4 a r �'' 1, ak. ¢. 1, =. i��; � � � .:lt.+.i' ..a i. .� ll �,� i [� sf'7v i 4 a'
Reviewer/Inspector Signature: j,,`�.�, f Date:

P,.
Division of Soil and Water Conservation 0 Other Agency
t3 Division of Water Quality
Routine 0 Com laint 0 Follow-u ' of DI ins ection O Follow-u of DSWC review 0 Other
Date of Inspection S i
Facility Number 3( Time of Inspection 24 hr. (hh:mm)
Registered Certified © Applied for Permit 0 Permitted 113 Not Operational Date Last Operated:....... I ..................
Farm Name: 1, x.....(r.e .....:...��rs........! .tr.. .. ...................
...............�i11.t- ......� � .... County:...... . .r4.................,....,.+......................................
Owner Name: .......................... 1l�kt,.e.S........... �st�.... s�r' Phone No:......�°L14.�.�91x..'....� `Y.. ............
FacilityContact: .............................................................................. Title:..........................,.,................................... Phone No:...................................................
p'
Mailing Address: .......31........ .8..!aVJ:..... .�...:....... ........... ....... " �Gv�hd�lf�....... f.ej
.................. .... ..5....
Onsite Representative: ...... J&W. s........................................................ Integrator:....Al......................................
Certified Operator-, ............................................................... .... Operator Certification Number;................--.-
,............................................ ............----.....
Location of Farm:
s'.cc ....... ...&.... 2 Z 0...i .... ih. i L
.. . ... ............ .. .
Latitude �',�� ��� Longitude �• �� �'�
General
r
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. 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 [P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [j No
c. If discharge is observed, what is the estimated flow in gaUinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes W No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [P No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 4 No
7/25/97
Continued on back

Faoility Number- 31 -- '7��
dt 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes allo
Structures (Lagoons,Ilolding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes X No
Structure l Structure 2 Structure 3 Structure 4 Structure. 5 Structure 6
Identifier: 2 3
Freeboard(ft): �.`�.............................. ....... .:........................... ....................................
.......................................r.,......:..,.........................:...................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes No
12. Do any of the structures need maintenance/improvement?
M Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify MVQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers"
❑ Yes
No
Waste Application
14. Is there physical evidence of over application'? ' "
❑ Yes'-
[O.No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............n................CP..IC ......W......54 £.,...................... .,..............
...........................
.......
16. Do the receiving crops differ with those designated in the Animal Waste Management flan (AWMP)?
❑ Yes
[j No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
[ No
18, Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
® No
20. Does facility require a follow-up visit by same agency?
❑ Yes
O No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[9 No
22, Does record keeping need improvement?
X Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes T No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KR No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes [PNo
0 No. vioiations or deficiencies. were- noted during this visit.:You.will receive no further
correspondence about this.visiC,:,'...
,�} ;
Comments (refer to;questtEon #) .Explain "any YES answers and/or ati, recoinmendattons ar:any oilier coittments
Use drawings4facihty-to Netter k damn siiti atiom (use,additi6nal pages as.:necessary) f w a fw.
tL Crester` artt}l 0— Ati- +n,M1ur fa�k� d.~,� will o•� � - iatOO-i Sk-L1J die �ifV ret � •
it- Cctr.�i�u e.�-6 6
fie: nnti�cav� l�e,r(�n►�b�a�. ` j ( �t �Vv3�� 6c rs
�pl� �p � IIt-'�['�1 T Ka v (Uf ,r['l e ��� \c,1

Facility Number
Date of Inspection
Time of Inspection OtIfi 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:......„ .........................
FarmName: .... ..ta.....C�..]P:.............. ................................... .....
Land Owner Name:... „.. .....»..................
Facility Conctact:
Title:
County: _4.�k. -.�............................ LVIJ&.U.
Phone No:. y............................
....................... Phone No:..........................................................
MailingAddress: ...... Z.L.V .... ! .. ..... C.a.....:..................... ......... ..... ...................................... a. ...
OnsiteRepresentative:..... ......... Z8i.�1.-,.r ...... „......................... ........ integrator:.....................................................
Certified Operator f-
p.............»................................................................................................, Operator Certification umber:....�..{i�..i.Sl.�r,.................,
Location of Farm:
Qra................... ,a ff.".K.L..ti:tr..A.11. .. ............. ZE ..........x�►
....r..�..f.i.�.Y,.......t�......5.jai..q.a..,................................... ........................................................ ......................................................
.....�
Latitude 1• EIZOi ®44 Longitude ©' ®4 ©11
Type of Operation and Design Capacity
Des n ���� �� � ar �, ��
Swine -Design
Design Cu°went . Design , .' Current
=Ca aciye�;I'o ulatiopPoultry.t�Ca aci ``Po ulation Cattle, . Ca aci Po oletion
CK
Wean to Feeder n6V El La er ❑ Dairy
[I Feeder to Finish `r ❑ Non-LayerIELNon-Da'
Farrow to can
El Farrow to Feeder 3' J§,i TotalXDes gn,Capac1' (,0z)
Farrow to Finish " ' w r
v.m ..._ ❑ To ! SSL
Other
'x:^;' .;;+ryp°1�°'�.r:3`�""" a.vv�• .�, '� ,.�-ski r : �es�`...�€�a,: ,•:�.'kS. i5��..,�:s�'�.s.
NumberoflLagoons / Holding Ponds ❑Subsurface Drains Present
" f. t Lagoon Area ]❑ Spray Field Area
Gtneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
2. 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 Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? 01A
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 P No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 0 No
4/30/97 maintenance/improvement? Continued on back

Facility Number:.._ 1......
—..: .
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structu Pis (Lagoons for Hq„dine Ponce
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
2.....�........ ... ........................ ....... ................... .
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
[:]Yes 19 No
❑ Yes ®No
❑ Yes V,No
❑ Yes ®No
Structure 5 Structure 6
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 ! :.......... ..Q5xA.ir...... ............................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
JEor CertifiRd Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes 10 No
-B Yes ❑ No
CR Yes ❑ No
❑ Yes ® No
❑ Yes [No
❑ Yes ® No
❑ Yes ® No
❑ Yes
R No
❑ Yes
No
❑ Yes
No
❑ Yes
]@ No
❑ Yes ® No
❑ Yes ® No
Yes ❑ No
Comments, refer to`;queshon #) Explaut ariy YES'answers and/or any recommendations or any other comments . E `
Use.drawings of facility} to better explain situations-.', se additional pages ais necessary) t `
11.112 o L .i e,_j-e.4 . a- t,- _c i c-o ,r
v.) a L [-v 6 s 1-o v I eL b Lad o_� ,r env e. 9- E-a t-A4- (—
to P-Y-e- 5 p, t s o n a. L r 4L b 4- yr e._,. �� e t-.
jA-- t-c, 'F"F U +,, I v.1 a`f' i ►� v L w,r ,�-o w- q .
ZL4 (sa 4- c v Y-v—&-� t So i' l S v_-v-r.(- w A .t t-e. s 1 {-%k. 9-e tv, . ,'� is a� w^a,
Su ,.-tr L-`�ai t t"L f. t,_%1
,nn_ 'P�v►�k-vim_ �r ¢ {�.� o� v�� �'`! `r� �'��-+mot. 0-v� � G-V � t r ri p u L'L� 0 -t
J
�
Reviewer/Inspector Name -t�"� .:� . . ,,
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97