310834_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

J
Division of Water Resources
Facility Number ©- I �*G ��-!I 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: c. ai l ,lSLM�i
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
ory rou_nry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes AEINo ❑ NA ❑ NE
❑ Yes,,-ffNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes 'Lg-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 E3-No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes E No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes ;>e'
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff 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):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes /'--' No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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? T
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, et .)
❑ 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 zzrNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes oNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P
No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes o ❑ NA ❑ NE
❑ Yes t ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Z�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
❑ Yes
. �Io
❑ 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
�io
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑Soil Analysis
❑ Waste T
ansfers
❑Weather Code
❑ 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
o
to
❑ Sludge Survey
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit Yes PNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes PrNo
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 P'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T❑' No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ONo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Zj No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑: Yes 2�`No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes eNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;sNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes VNo ❑ NA ❑ NE
34. Does facility require a follow-up visit by the same agency?
❑ Yes z No ❑ NA ❑ NE
Comments (refer to question #): Explain. any YES answers: and/or any additional recommendations or -any other comments. `
Use drawinjzs of facility to better explain situations (use additional pates as necessary).
O•q�
11019
r•s�
Reviewer/Inspector Name:
• Lisp /12tJ
4-o cover OaR--.
fury//t)
MtV Cd s`UC6c- �(A,&v
rs
S�rv1��,5 Ls (,or,��
`zG C S: t VAre— 5 �_kf UleA
Ca t �i�r4j-L�
Phone:
1a
Reviewer/Inspector Signature: Date:
Page 3 of 3

,{ �vts�onotWater Qualtty,
'N' ai:l�. y„ � f +Fk °��'a �i�i��t,��'�-
o FaClltty Numbers ,:Q.�Division of sotlandWater�Conservation
;r.I :a.st tt t tt fits a4: !t .s'!''{ ■�%e s> 0 3ht; �m y � �i
Type of Visit omp[lance 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: 1 /2
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: �Qjl� eparture Time: County: Region:
Facility Contact: Title:
r J
Onsite Representative:. � [ i 61 ez
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o = Longitude: 0 0 0 ' = "
' r!'>8.4"0t".� 1ji__Tg"f
:z;a '..iDestgn Current`, i.:aDestg!t Currens
. k 7tSitY
,ti;,it Destgn Current:
r pt...
Swore. a,: t
+•, , i�� CapacityP,oul�tront;WetPoultry� CoCupa'c`ity,Populationt.� �,
ii?,
Cattle CapacrtyPopulat�on
'&�-
:dauT�,� ; z: �-�� �g�n ..., � r a.,g` € �"r6rts ��.Ci,.4a .3.s.Y�,.trzt;:_x.��_�=.:t .. a �3;5`tin�f4"ix
❑ Wean to Finish ❑ La er ❑Dai
Cow
❑ Wean to Feeder
❑ Non -Layer
❑
Dairy Calf
❑ Feeder to Finish tag, ¢,
t, t�j�
Dairy Heifer
��'d�t
Farrow to Wean tt
❑ ����DryPgultt�yf�,,
$m�
,is : - a its❑
n c s
p �i
t
D Cow
❑ Farrow to Feeder
i ❑
Nan-Dai
ElFarrow to Finish s ❑ Layers
El
Beef Stocker
❑ Non -Layer
El Gilts s
� El
Beef Feeder
❑ Boars El Pullets
❑Beef
Brood Cow
ElTurkeys
❑Turkey Poults
;. i
r $ ❑ Other ❑Other
i� Number o€fStructures:
g•
R mob'. ..d mUt i.: :d F 8 8 Fx ar.,:-�- --�
ilF'
rg yF
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
16No
❑ NA
❑ NE
❑ Yes
O-No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes Z-No
❑ Yes
1No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: - r3 Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ff No ❑ NA ❑ NE
Struc e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .ETNo ❑ 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 /EfNo ❑ 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 ,ZrNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ;2,90
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes WNo
❑ 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, et ,)
❑ 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):
U. Soil Type(s):
I4. 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?
❑ YesTja No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes J2�No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ YesElINo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [3 Maps ❑ Lease Agreements [DOther:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes,,allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,E!j'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA [3 NE
Page 2 of 3 21412011 Continued

Facility Number: -QmlDate of Inspection: 12,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [:]No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [:]No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes C] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes [:)No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.`
Use drawings of facility to better explain situations (use additional pages,as necessary).
Lgd 4zt2 7 L5/ta-te 6f �p qc
)4
t Il,112, 0 • qe�
J. g
lG
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
LOC 57 e n yw 1 bV 5 IS
6a� '6o &q-t5 �arWajrj
5
a- G C &Lw ion .
S�e Sup vim. � �,�-�►-�
Phone: : 799 — 7t/c
Date:-
�14/2011

Jornivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
r
f Visit S�Compllance Inspection 0 Operation Review 0 Structure Evaluation
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency
Date of Visit: / Arrival Time. Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
(,technical Assistance
0 Other ❑ Denied Access
Region: �(
Facility Contact: Title: Phone No:
Onsite Representative: c Integrator:
�+� a
Certified Operator: Operator Certification Number: _ ,2d /6 /� �1
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean,
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = l ❑16 Longitude: = o = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp_es & Stream Impacts
I. 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
❑
Dai Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stacker
❑
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 Lam] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ,16No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
Vo
❑ 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? ❑ Yes ;jNo ❑ 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): 12-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ff No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes AfSo
❑ 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 ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZrNo
❑ NA ❑ NE
maintenance/improvement?
,�{
11, Is there evidence of incorrect applicationxJ'? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes/dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,21"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes d
[I NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ ��No Yes
❑ NA
❑ NE
'. tze. •: r «�aa $.��;it:. •r.��t..,��C i.ed w:X►f f.,�'. s.� �'AT..�,. 6.W
Comments (refer to' fiestion #): € Ezplain any YIJ5 answers and/or any, recommendati6ns orb anyY6ther,;'comments
Use drawings of facility to. better explain situations , (uwiiddihonal3pages� r s necessay). YY i
Reviewer/Ins ector Name g �" ` _Y 'r' �1 ' '°
P r
*—
Phone: 7�,,�
a ;_, , ...
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12/2k/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;2&o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. PfYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
7No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Acl'ditional Cgriiineuts, and/or Drawin S +' F
i
N S 1
Ats s
!r � av"'-4s'3 4
3 iii///
4 �
43 Su n�a
Page 3 of 3 12/28/04

Type of Visit AEr—compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0of outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: C% Departure Time: County:
Farm Name:4�Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: %' Title:
Onsite Representative: s.Z4
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: Zd-1 '
Location of Farm: Latitude: = a 0 6 = is Longitude: = 0 0 ` 0 "
resign Current
Design Current
Design Current
ne apacity
Population"
Wet Poultry Capacity Population
C*a'ttle
C«apac�ity Population
RrWean to Finish
❑ La er
❑Dai CowWean
to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑ Beef Feeder
PBoars
El
❑ Beef Brood Cow
Turkeys
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZrNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspectionjr
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other ,-tv�^
o
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .ice ❑ 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 O-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ✓CJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PkNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes [;Ko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 12Mo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes )2 Io
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ErNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ;2' 4o
❑ 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 ❑,Ado
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes [ o
[I NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
/'
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ;;"No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes �o
❑ NA
❑ NE
Additional Comriients and/or Drawin s ; r 9
s i ,« e;';
t. � s , ,' N,
s b
Used
rr 6 z4czr,
AOh2
�3.
1� . e Ar
ey le -
Page 3 of 3 12128104

I.FaciLity Number: —499 Date of Inspection X
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes v' No
El Yes • PNo
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [INA ElNE
through a waste management or closure plan'? X
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 ,ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 ;2Mo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes hIo ❑ 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 Driti ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;2 1&o
❑ 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 acre determination ?❑ Yes ;;�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,e lRo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes , to
❑ 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):
la-c.+vr r2.
Reviewer/Inspector Name VP • lLX V61
Phone: i
Reviewer/Inspector Signature:
Date: ly
12128104 Continued

Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /Q , Arrival Time: �,, / Departure Time: 1 County:
Farm Name: dLL A1�1 /d/m'? Owner Email:
Owner Name: �L,G �iP�L/j Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: O��
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c =' = Longitude: = o =
Design Current
1Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
I0 Layer
❑ Dairy Cow
Wean to Feeder
1 200
p Q ❑ Non -Layer
I I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cow
El Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number Df Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 9No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes ❑No
❑ Yes ONo
❑ NA
❑ NE
❑ Yes '10 No
❑ NA
❑ NE
12128104 Continued

Facility Number:—�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier: . 30 7!Z
Spillway?: 0
Designed Freeboard (in): /Y 5
Observed Freeboard (in): 211' 433
Structure 3 Structure 4
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 ZNo
❑ Yes ❑ No
Structure 5
El NA El NE
❑NA ❑NE
Structure 6
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes 0No ❑ 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? W(Yes ❑ No ❑ NA ❑ NE
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) 10
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ElNE
maintenance or improvement? 40
Waste ADDlieatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2rNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) L� �ncJ1JA1GQAZ�, , ,.5. a, Loal--jK6—
13.
Soil type(s) &'6 —�a A
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
ElYes
XO
9No
[3 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): .
Reviewer/Inspector Name — -
I Phone:&,O)�fa�3
Reviewer/Inspector Signature:
Date: la A. O
Page 2 of 3 12128104 Continued

Facility Number: — 3 Date of Inspection O O
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ;Z Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JVNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ZYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
�10
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
El 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
VNo
❑ 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
XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J0No
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
2`f 25/IMos 7 8e D®, j, A ,4P Sf E ,G,�rf�52o�•/ She t/reF,
�% 41 ��%��) 3S0 -Z0a {
2�! -A eR�S ©N ��� � ��N 7 /� ►�C� �i27�.�7tpn� lC��.S
�oCJ E,.
i� �LJ©o2 L �sL
�o Q 40j;
A)D�f
f:2-W,64 41 Z' GrgDr�ZD
Page 3 of 3 12128104

L
f Visit Q'�ompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
for Visit ,QrRoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
�
Date of Visit: l� Arrival Time: f O Departure Time: County: D- 4 /4 Regionl
Farm Name: A!9 / I / r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = ° = 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish 0700
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
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 P-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'o
El NA
El NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection / G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes .OTVo ❑ 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: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E]'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 ["No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 ,O 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 ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dritl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�?No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
_UNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
;3-No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
qNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
oNo
❑ NA
❑ NE
., '. -. - - - •: . - �-� 4 ' ii4 -' i '�" Pt. .��y'x
Cottiments {refer to question #)xplaen any YES answers and "a /orny 'irecomme idations ' or,any�other ;mment.ti
cos3 t
Ilse drawings of facitityto,bi tter explain situations -,:,(use additional;pages as necessary) tr,*A V
,.
Reviewer/inspector Name vµyj _ �C! Phone:
Reviewer/inspector Signature: Date: l%Z k25-
121281W Continued

Facility Number: Date of Inspection
Required Records & Documents ,,{
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElFJ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 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 2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[2 NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ETNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
.KNo
❑ 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
X No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
, /�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�[
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'L,J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
6 No
❑ NA
❑ NE
..,�� .. ;: '- _ {. ...I � d.., i A ,. �,. t.Y-- .�j rt.t^�1-.�i•i� J.."'.. �
Aatlitional Cnmmen'ts 'and/or Drawings - S�l �i , y s■.� t
#.Y'J r ..l]U'} 1 dr'.� .�FM• ��N ..-F}Mf u�y.$ M .. {Fx' FN
Awl co J �e- oy►S
C l af
f2ccordS ►� a� �- d y
Arl Ali
12128104

Type of Visit -ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: r Time:��
Not Operational O Below Threshold
0 Permitted 0 Ce`rOdfieed' [ fCfonnditionally Certified [3 Registered Date -Last Opera Abov Threshold: ». ».».. »....
Farm Name: .... tdJ.. r a'••••� i['l ..� �. ](.. L �. � County:. 1 _ � ».........
_.. .... _..._...
OwnerName: _ ..............._................. ......_...................................».»...... 'Phone No: ...».......... ........................... ........ ...................... ...........
MailingAddress:...». _....._..._...........» ...._ .:..__._........ _..... _.... _............... _......_._._.._.__._ .._ .
Facility Contact: ..___....__ _ . _ -------- Title:.._ _ ...__ _ . _ . _ . _ . _ _. Phone No: »._M
Onsite Representative: _ . _ __ ._...._____.. Integrator. - _Ii
Certified Operator:. ... »...._ ....... _................ ..... ..».... . _. .»......_.........._....._........... .. Operator Certification Nu12.
........_.»........»..».».
Location of Farm:
— I-W
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude "
Disebanes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �" o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E3110
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [-]Yes 0_1�0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 131qo
Structure 1 Sw e^2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �'j �/
Freeboard (inches): CJ
12112103 Continued

Facility Number. — Date of Inspection v
5.'Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ..E No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes j2No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes �?No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ff No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes J:Wo
❑ Excessive Ponding ❑ PAN ❑ Hyd ulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with tha designated in the Certified Animal Waste Management Plan (CAWMP)7.
❑ Yes - TNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 12-90
b) Does the facility need a wettable acre determination?
❑ Yes ,T1 To
c) This facility is pended for a wettable acre determination?
❑ Yes ,ZNo
15, Does the receiving crop need improvement?
❑ Yes oNo
16. Is there a lack of adequate waste application equipment?
❑ Yes . B' io
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[j yes ,ONO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
,
❑ Yes a No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes ,,Emo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes E Vo
Air Quality representative immediately.
tuv.� r �, •a,A � ia.?'�m �•'� •..:�3a�1�,.,.,, ssc:;.»�^�±na. �c+mxrt�st",iucvti±g:vu�� •rr.�uurs �����vv�:su�:h:°s:,.san:vn';v.r„•f�� s� av ,r^•:>a�i3 ��^:��u� rk:re:-»^!�r� a�^!y , �
omments (refer to gnestion )z F�cplata away YES atrswersjand/orgaaya,recamrnepdalioas oranyrotlter,aomments: �
�
� x '.�i'!dra � nt4;#iStN's �. ""`.N%4� � ! '� WE � '•":wail: if�4^'R'l�.a�;z�:q�:'ShY.S,:A1174kts"h'�SNfC4? ❑ ' —�•µ.• .•-•:,w4w.:aru.:,:� �+.P:.tai �Jse(ry` 93w9 offait4ybe"tter4earplainsi�qutttio {ihoinai pages aqF;svgwr,�y g w Field COPY ❑Final Notes,ts g
ta't.ro��:1x 4aReviewer/Inspector Name 4r ie�:�
ReviewerAkspector Signature: L_ Date:
iW iF/YJ vv/.M/.wvw

Facility Number:,":?—,?Zr Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ,EyNo
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
8'No
23. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
,J?'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
2No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ZNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
014o
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,ONo
2& Does facility require a follow-up visit by same agency?
❑ Yes
.B'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑'No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ORo
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
a3� AaAle rno% rfulas
- tie su/e 7�)
u,�rrr�/rzJ
12112103

i. ,
Facility Number Date of Visit: Z OL Time: �+
10 Not Operational 0 Below Threshold
19 Permitted E.Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 6#4-+� 1- j gam` County: 44jgl�r�
•.
Owner Name: j7ely U5k°✓ Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: &,ge✓
Certified Operator:
Location of Farm:
P��ho--n e No:
Integrator:A
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 11 Longitude 0 f GG
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
CaDUCitV Po ulation Cattle Capacity Population
® Wean to Feeder
❑ Layer
I Dairy LL
El--3Feeder to Finish I
ElNon-Layer
❑ Non -Dairy
❑ Farrow to Wean
_
❑ Farrow to Feeder
❑ Other
;
❑ Farrow to Finish
Total Design capacity
❑ Gilts
❑ Boars
Total SSLW
Subsurface Drains Present
Holding Ponds/ Solid
Discharges 8. � 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?
Area ILJ Spray Field Area I .
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
WasteCollection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 307q
Freeboard (inches): 21 ii
❑ Yes 09-No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [--]No
❑ Yes 3 No
❑ Yes Eallo
❑ Yes ® No
Structure 6
05103101 Continued

Facility Number: 31 — 53 Date of Inspection E2 �
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ® No
❑ Yes R No
❑ Yes � No
❑ Yes ®No
❑ Yes RNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
154 No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ Hydraulic Overload
❑ Yes
N No
12.
/❑- _PAN
Crop type _ &21 fA �t7'C+ '�&d 44 0,ft
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
® No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Z No
b) Does the facility need a wettable acre determination?
❑ Yes
"No
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15.
Does the receiving crop need improvement?
;E Yes
❑ No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
BNo
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
IS No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
59 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
13No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [S 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 �9 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [ZNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
" art ._fe.sx,. xwc:ka.:-.,
Comments {refer to',giiestton:#): Explain any YE5 answers and/or any recommendations tirtiny other comments
""rr �:
S.eg h 7..i S
Use draw ingsfof facihty�to:better explain situations ?(use addittonal pages as.necessary) ❑Field Copy ❑Final Notes
%9 Sn/I -4frnl1e IVA hod- -H eri ,der 2-001, 0O04 .So' %l 5�,•�/es i•,/t7`eA/. ,4G,
6 needQd 4,­ 4e ldf.
zo /,- -Fit? 14 /1 3, 5'i 'r 7 i/�✓ '70 � ik �Ooa Slt,c�p G r ;� /l`✓i
G�-7�• �•
heeed im�roUeM .[•wea nvooi/d44
i /Hv k he tl is ,� r�
ReviewerlInspector Name
Reviewer/Inspector Signature: Date: 2 Z
05103101 .� Continued

Facility Number: 3i — 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 atfor below ❑ Yes 19 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 S No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes R,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 P�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 10 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 01 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes k No
Additional Comments and/orDrawings:
f
5100

jo Division of Water Quality
0 Division of Soil and Water Conservation
r.
Othe:Ageney
'
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification 0 Other ❑ Denied Access
I]at.eorvisit: ®l'imr:
ty Number � Printed on: 7/21/2000
Facili
0 Not Operational 0 Below Threshold
Perinitted 0 Certi@0 © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
FarmName: .................::.....''1.................................................................... County:.......... 1A ........................... .......................
OwnerName: ......................... Phone No:.......................................................................................
FacilityContact: ...............................................................................Fitle:................................................................ Phone No:
MailingAddress:.................................................................................................
Onsite Representative: .,'.In%^Q............................................ ............ Integrator: +r#'..................................................
................... ... .....
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
I&
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• � ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wcan to Feeder ;10 6 ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
[I Boars Total SSLW
Number of Lagoons a ❑Subsurface Drains Present ❑ Lagnnn Area 10 Spray Field Area
Holding Ponds / Solid Traps i ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation'? ❑ Yes �<No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b, if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the estimaled flow in gal/milt?
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 tErNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge`? ❑ Yes D(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes No
StrUctUrc I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Frechoard (inches); r�Q a C4
5/00 Continued on back

. Facilitay Number: — Date of la?spection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closureplan? ❑Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? WYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes NTo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �rNo
11. Is there evidence of over application? ❑ Excessive Ponding (j PAN ❑ Hydraulic Overload ❑ Yes k No
12. Crop type � 19
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?
Yiola(i o is,oi- ii . clenoes -were hated ditf.�tig tbis'visit: • ;Y:o4 'Wfl1•r. eeeiye ii6 furthi f .
• ;corrtzsporidence. a�aut. this visit . - . - . . . - . ..... .... .. - . - . . . . . .. .. .
❑ Yes �(No
❑ Yes kNo
❑ Yes KNo
❑ Yes O(No
❑ Yes XNo .
❑ Yes ,�(No
❑ Yes �(No
❑ Yes XNo
, 'Yes �")Otl
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes XNo
❑ Yes E�No
❑ Yes ONO
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
c b
Reviewer/inspector Name i -� �(q ' 31 S )U
Reviewer/Inspector Signature: Date:
5100

• FaciPity Number: 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
O'Yes
❑ No'
liquid level of lagoon or storage pond with no agitation?
\\
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�j 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
�`j No
\
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
J
5/00

Division of Soil and`Water`Canserva4on Operation Review
10 Division of Soil afidMater Conservabon� i.Compliancekltispection''II,II ,f ��lf�' ; t' �',` 't�E,,,tpi,;i}I,;E
V DiAsion of Water-Q`Frahty� f dkCompleanee Il5peCtlOn' € 3 rE k 3 '1' 1I� � ! i `I' ` I ��. n ° 31��� '�fp{,hl
i ©,other Agency - Operaho9i;ra'�RevrewP, ti I s 9 i mr } ltl t -,i i i If N� t I
s,..
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection :llb 24 hr. (hh:mm)
© Permitted Certified [] Conditionally Certified © Registered [3 Not O erational Date Last Operated:
Farm Name: I �:!�. .. -.IV . 14AA.. � �. �� County:....... /f: ..................... ...L.r...........
OwnerName:........1.................................. 1..Lfl......................................... Phone No: ........
./..�9.....�1...y...:..d..........................
ii ,
CCC -f
Facility Contact: ...... ,{7 ............ ...........�+Lei!G.f`........ Title: ...... ON.V..t.v... Phone No: ...................................................
Mailing Address: ..........�.r? .........�:� kUvnrl.lt __........... .4 ......................... ..... �6-t.......... 1't`1.�.�.. ......... tom..........,. a ..
Onsite Representative: .&L.... 7,kLL tl...............�1� !�•S✓i'I�..... Integrator: ......... Alfr..............................I..........................
Certified Operator:............................................................................................................... Operator Certification Number:..........................................
Location of Farm:
............................. ... .... .. ...................... 7
Latitude Longitude
Design
Ty,:..Design,.. ,Design
Current
Eo ulaton aaIkSwine C,`,Cap atPatoe
` Wean to Feeder 1LV ❑ Layer ]""ED:airy 1.
s
❑ Feeder to Finish ❑ Non -Layer r'` ❑Non -Dairy ;
❑ Farrow to Wean'
[3 Farrow to Feeder ❑Other1.
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars ', .Total:SSLW
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: [ILagoon [ISpray 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 ycs, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Il'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ......21................. ....�<7............................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion,
seepage, etc.)
❑ Yes 9No
❑ Yes 9-Po
.y1,f
❑ Yes ' No
❑ Yes No
❑ Yes T No
❑ Yes 0 No
Structure 6
❑ Yes M No
Continued on back
UPACUSU

Facility Nuiiber: — Date nl' 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 maintenancelimprovement?
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. Fait 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?
(iel 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?
(iel discharge, freeboard problems, over application)
23. Did Reviewerllnspector 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?
IQ viola�iQns-or deficiencies Wv re hofp . 00iiig •this'Visit. YOir will-eeeoiye iio fui-th�e .
• corres�6ndence. a)baut. this visit
❑ Yes �No
❑ Yes A No
❑ Yes J4 No
[-]Yes XNo
❑ Yes Ti&O
/-
[]Yes JNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
RYes ❑ No
Yes ❑ No
❑ Yes FNo
[]Yes ,FNo
❑ Yes j (No
N"Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 91 No
❑ Yes (kNo
❑ Yes g No
❑ Yes ONO
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Use drawings of facility to better explain sttuahons..(use adclittonalEpages,as necessary)•i ! ! , li
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...�1 � 117z r3,l IE',.rE -jReviewer/Inspector Name . ti:• t V� trn� ;f [��rl v�Sr�+w� ° I •�[+"*�- ��� � �i � l El yE E�, "' � r
Reviewer/Inspector Signature,;_ '—l/J/f„ {/,,,/ Date: Aw Y + cfq
_pkv� { y/U�.3GIS'.�� „P/rEf�.�.Zs. 3123199

Facility Ntoinber:
Date of Inspection
Odor .Issues
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of'properly within 24 hours?
❑ Yesfo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
V0
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
NNO
/ '
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
�Klo
Do the animals feed storage bins fail to have appropriate cover?
❑ YesX11NO
`31,
�$.Do
the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
o
Additional ontments ani ur rawtn w �'.
"f ilE
/VO
Goo SD
3/23/99

III Division of Soil and Water Conservation O'Other Agency
Division of Water Quality
Routine O Complaint O Follow-uPcif DWQ inspection O Follow-up of l)SWC review 0 Other
Date of Inspection P 9
Facility Number
Time of Inspection �� 24 hr. (hh:mm)
© Registered 1� Certified © Applied for Permit 0 Permitted „•
rNoi Operational Date Last Operated:
Farm Name: ......... A.!U... Os1rk....... txze...... ....�r..................................... County:....., r.......................... ............. ........................
`E Owner Name: i� N.....t 1 ....NAY .� 1.C.S......l t!� Phone No: �..............
r1 �....................... ......................
Facility Contact: ........... s?. ....... V.�IAv................................. Title:.........................
Mailing Address: ......... 3.5,i.,i: .....V u.i MAx....:.. _..:...
Onsite Representative: ........... din:at......:U�Lxar ...........................
CertifiedOperator-, ..................... ........................ ..... ............................ .................................
Location of Farm:
....................................... Phone No:...................................................
�.....1.(.E...,.....n.1.................................... Lam........
Integrator::...... ..............................
Operator Certification Number; .........................................
1 .....r...a�? .,....t s. ......... ...t.1. ..L.. .:.S... ,m± L&..... ive.5... 110Z..............................
...... .... .
Latitude Longitude
Q Design Cur "rent
Design Current > Design Current
Swme
rapacity Population
.Poultry , „
,,,,,;,Capacity Population's Cattle ` ,,, ,, Capacity .Populatiati ;
Wcan to Feeder
51_00
:',
❑ Layer
❑ Dairy
❑ Feeder to Finish
G°'
❑Non -Layer
L
❑Non -Dairy
�.
❑ Farrow. to WeanY'
'�
❑Farrow to Feeder
❑ Other
a .
[I Farrow to Finish
Total Destgt� Capacity
❑ Gilts
Boars
lotaI.SSLW
N"�b of Lagoons'/ Holding Ponds 2
�:
Subsurface Drains Present
❑Lagoon Area
Spray Field Area
y� q ' ''' .❑
No Liquid Waste Management Systemy`
�3H.-,J"`m'
,iv.l3n �2'Q`.; 1. v'."
„i.F`
General
L 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 [T No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [M No
c. If discharge is observed, what is the estimated flow in gal/min? _
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® 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 ® No
maintenance/improvement?
b. 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 (B No
7/25/97
Continued on back

Faiility Number:
f 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes M No
Structures (Lal oonti,Holding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes jR No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure fi
Identifier:
Freeboard (ft): ............ ................ .................. Z 7
10. Is seepage observed from any of the structures?
❑ Yes
M No
11. is erosion, or any other threats to the integrity of any of the structures observed'?
Cl Yes
P No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RLNo
Waste Application
14. Is there physical evidence of over application'?
❑ Yes "Ia,No
,
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....................�Rrrtttt I....................... ti.?tii.rL......,....................
p Yp I......u, ...... .............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
M No
rYN
17, Does the facility have a lack of adequate acreage for land application?
❑ Yes
CUNo
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
.I@ No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
U No
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 10 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
0 No.violations or deficiencies were-nate'd during this visit.- .You.will receive no further
0&6po>idence about -this'.
Use d awtn'gs of facility'tobdt�ef 66lain'M uations (use additional pets as necessary ^?'' x {' x " t A �
12. Bare_ a*tos 0,, its I� to^ d w41 skoujd )3c Irev,,Y4P_W. E"skor-� can �a S o+� �,,,,t,Y . •
M F (�500� 4 l e. 4(UJ 'k--
I$• 5koW 6! 4, 61 c- 44, 5�441 K, far (jeedt etc.
ZL. �O�Y1n� C-Et�ti I•tCD�'f�8s� �'ar �iHS@v �.t S�bvl� 17e ir` v
7/25/97
Reviewer/Inspector name
Reviewer/Inspector Signature: ��Jj f l,_ _ Date: f p J94

.r-
Routine. O Complaint O Follow-up of DW inspection O Follow-up of DSWC review O Other
Date of Inspection-1/30/41
Facility Number Time of Inspection : 5 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/Least Operated :7.................................
Farm Name:..' r .� ��r� !A.....1•!'+�1��Pi�!�l•#1 ...............................
Land Owner Name:.......! �.......t.uk,..... tYui,:s.... ................. ....... ».
Facility Conctact:.... ....... . ............................ Title:
Mailing Address:... .5. 2......!` any...,...F4.............................................
Onsite Representative:..... ..............
Z-1.. ...........................................
CertifiedOperator: ............. . ................................... ............................... . ............... . ......
Location of Farm:
County:��,............. ........................ .d�lJ�
Phone No: .:d.......'...�.a.QB�.................
........................... Phone No:..........................................................
....i....11..,.......UC............................ Z.2..`15.....
Integrator:... !i �..................................................
Operator Certification Number: ...................................... ..
..O.VN....uw.a.!G. ! .... .!. �.........a .... }.......i.v..r.. 71.1�A.x!! kAs.... .. L.?.... .....snn a..l.t.,t... .ar.
c....:.,�..rvs�.t;..�.a..h,......u.�.. .....,. .................................................................................................................................
Latitude Longitude ®• ©4 "
Type of Operation and Design Capacity
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes 19 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 RNo
c. If discharge is observed, what is the estimated flow in gal/min? _ a4
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 9No
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 ❑ No
4/30/97 maintenance/improvement?
Continued on back

Facility Number: .3 ..... ....
• 6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 9 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laagaons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
.:..�............. ............................ ............................
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 ® No
❑ Yes ® No
❑ Yes I&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 .."Y.:� . ..J.-A....... . t .fin p .�.1... e�.r.a.rs...................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does 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?
ir.. to
re t
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e S
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I g. C.o Yv¢.. f W ,k_, r + -a 17 l Fiwt • 1 v, 14.2.. � ,,,.,- C kvj .
❑ Yes [9 No
S Yes ❑ No
&Yes ❑ No
❑ Yes ® No
❑ Yes allo
❑ Yes [a No
❑ Yes MNo
Z Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ Yes [9 No
d W\ ill S t.
R
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: }
cc: Division of Water Quality. Water Quality Section. Facility Assessment nit 4/10/97