710072_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental 4uai

'i .
Division of Water Quality.
Facility Number Z 0;;Division of Soil and Water Conservation
eV Other Agency
Type of Visit Xcompiiance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral JeEmergency 0 Other ❑ Denied Access
Date of Visit: 1 0 Arrival Time: ; r0 Departure Time: County: Region:
Farm Name: f/e Owner Email:
Owner Name: eqAwo Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: I Integrator:L�S��(-c�i'�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine.. .
R❑ Wean to Finish
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = t = Longitude: = ° = =
Design Current `-Design Current °Design
Capacity Population ;:Wet Poultry , Capacity Population Cattle - ;;6Capac�iy
Feeder to Finish IQ
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
ILi Non Layer I I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
i _=j
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field Z Other
a. Was the conveyance man-made?
❑ Daty Cow
❑ Dairy Calf I vim
❑ Dairy Heifer I r
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
0 Yes ❑ No ❑ NA ❑ NE
[--]Yes gNo
❑ NA ❑ NE
❑ Yes oNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Z No
❑ Yes ONo
❑ NA ❑ NE
❑ Yes ONo
❑ NA ❑ NE
12128104 Continued

Facility Number: Date of inspection ! 2 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0Yes [:]No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 9Yes ❑ No ❑ NA ❑ NE
Stricture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: A O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes oNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 JZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenancelimprovement?
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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windgw ❑ 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 JATo
❑ 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?
/Z
El Yes JeNo
El 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):
r
Reviewer/Inspector Name L Phone—%1Z�7!
ReviewerAnspector Signature: Date: !
Pane 2 of 3 12 R104 cantinued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box, ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
VNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
YrNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
gNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA A NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
JONE
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 ONo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ .Yes
XNo
❑ 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
XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Oyes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
0 ilk o��Gz-T�v�7s•2�E '
G�/rif�24
yGc%Lks?� �OuJ � u�Ei✓ � �oP��a CL)�Srf /�o� �o � �
�� t /��0 A�"il �tz•� �— �F C.C/.�-s ff /�''o .fir .�C_ ,� � G,S�.oa.J.
�iQO/'y1. d ��r�idDrJ /n � %�C� " �' `/� �i/✓/� / `f��C.Z,/`�_ �� �CJ.�"�E.
Page 3 03 7d 12128104

4
so Division of Water Quality
FaeiGty Number ! _O Division of Soil and Water Conservation
— .D Other Agency
Type of Visit grCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency XOther ❑ Denied Access
Date of Visit: 3 Arrival Time: I `T►�iV�/A1 Departure Time: ; Q County: Region:(/
Farm Name: Owner Email:
Owner Name: L Phone:
Mailing Address:
Physical Address:
Facility Contact: n Title:
Onsite Representative:
r, n�
�/% Phone No:
Integrator: ' ,
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 = = Longitude: = 0 0 i = r`
Design Current Design Current
Swine Capacity PopulationF Wet Poultry Capacity Population
�1.10 Wean to Finish ❑ La er
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish ®El � -- - - — - -- - � — -- --
Farrow to Wean Dry Poultry.
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts on -Layers
❑ Boars ❑ Pullets f
-- _ -- ❑ Turkeys
Other, .. ❑ Turkev Poults
;„ ❑Other
Other
'l
Cattle C
6
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
`Number o€ Structures ,L�
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 '21No ❑ NA ❑ NE
❑ Yes
❑ No
[_]NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
[]Yes
[--]No
Yes
[:]No
❑ NA
❑ NE
❑ Yes )/ No ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection .3 D
Waste Collection & Treatment
4. Is storage 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: All
Spillway?: /yo
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.) to
,_,j
6. Are there structures on -site which are not properly addressed and/or managed ElYQ 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 )21 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)
9. Does any part of the waste management system other than the waste structures require ❑ YeNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [--]No ❑ NA ZNE
11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA/,I NE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA'T
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [-]No El NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ES NE
i
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 VNE
Comments (refer to question ft 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):
f1��C� � ✓� G ©11 14&11O 17 'Orn &�Ivy PF
-� R0��� ��,.. D��-,���
00,0 �%ar /�✓��2 �/1/�%,� �6 F
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: /v — 72-V
Date:.3 /) �-
12128104 Continued

Facility Number: — Date of Inspection U
Required Records & Documents ,,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ❑ No El NA XJ 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 ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
❑ NA
PINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ NA
prNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Cl No
❑ NA
P_ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
❑ NA
9NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ❑ No
❑ NA
PrNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
Other Issues
ZRINE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes F No
ElNA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes XNo
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes PfNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes )ZfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
/ r�
�it/�. 5 �� �/h`p 'CIF fir✓ j�iriJ7�! �J � 7�,� 1nl � o o N,,
auJs1JE� �,r}Z,D ��'�7 O�SC✓ l� �CeYQ2��0 A
��� ���
CrGFi /✓ZstiJC ! 7�2r.�5
"!/J D,
15/5L91a�
Page 3 of 3 12128104

Division of Water Quality
Facility Number[]:2i0 Division or Soil and Water Conservation
0 Other Agency
Type of Visit XCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
� 00
Date of Visit: � Arrival Time: Departure Time: ; nty: /-��f Region: �
Farm Name: z > A 0 0 Owner Email:
Owner Name: _ -._ /_)OA l 2 LL Phone:
Mailing Address:
Physical Address:
Facility Contact: __;� itle:
Onsite Representative: G�-
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
Gilts
Other
❑ Other
�o
Latitude:
Phone
/ No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
EEE11
Laer
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
LID —Turkey Pouets
❑ 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?
" =0�' =4
Longitude:
Cattle
Design Current
Capacity Population;.,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
[7Dry Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: IT]
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
❑ Y No
❑ NA
❑ NA
❑ NE
❑ NE
1 281044
Continued

pate of Inspection T^
Facility Number; — Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
)dNo [I NA El 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 El NE
(ie/ large trees, severe erosion, seepage, etc.)
/PP
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ICI No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ElNE
S. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
�O
XNo ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
o ❑ 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. 1s there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
R No ❑ 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 Acce table Crop Window El Evidence of %Wind Drift ❑ A plication Outside of Area
X'1Kh9rr,o
12. Crop type(s) SEf��
13.
Soil type(s)
/
Do the receiving crops differ from those designated in the CAWMP?
X14.
El Yes No
El NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
Yes ❑ No
[I NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes X No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ YesX'No
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes/(No
❑ 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):
/ -Odq_ 171,4$
4 ;
Reviewer/Inspector Name 6 4 Phone: rql 7--;L 3
Reviewer/Inspector Signature: Date: 2S D
12128104 Continued

Facility Number: / —T724 Date of Inspection E4 0 --
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X,No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P(No ❑ NA ❑ NE
the appropiate box. ElWUP El Checklists El Design El Maps El Other
``
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis�9Soil Analysis ElWaste Transfers ElAnnual Certification
❑ Rainfall ❑ Stocking 0Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YeXINo.
o El NA El NE
24. Did the facility fait to calibrate waste application equipment as required by the permit? El Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYeo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ YesNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ YesNo ❑ 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 [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 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 A No El NA El NE
33. Does facility require a follow-up visit by same agency? ❑ Yes !!!!A No ❑ NA ❑ NE
Additional Comments and/or Drawings:
9 r)- uj._D /vJP7
Aa;2
S.
12,28/04

e:-
Division of Water Quality
Facility NumberO Division of Soil and Water Conservation
— --
Other Agency.
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ElDenied Access
i -Z Q I
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Time: Departure Time: County: Region: �11 lr<V
Owner Email:
IL-1 Farrow to Finish I I I
Boars I I I
ier
Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o =' = Longitude: = o
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
UTurkey Poults
❑ Other
LI Non-Uat C"
❑ Beef Stocker
❑ Beef Feeder .
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
GYes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA/,,11 NE
12128104 Continued

acility Number: — Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElNo
❑ NA
ElNE
a. If yes, is waste level into the structural freeboard?
/(Yes
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
/No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
A
❑ NA
[INE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ONo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ 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
maintenance or improvement?
7NE
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 ;?�E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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
15. Does the receiving crop and/or land application site need improvement? XYes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
El No ❑NA
❑ No ❑ NA E`
❑ No ❑ NA�F NE
❑ No ❑ NA �E
[:]No ❑NA JONE
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):
Z) �ill�5 �SCh/i9l G,�
Tf11 �i�sT,F �nl iG Ile
out
IReviewer/Inspector Name GO Phone: 14-3 Z I
Reviewer/Inspector Signature: ,�� Date:
Page 2 of 3 12128104 • Continued

Facility Number: — Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA� NE
El Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA gfNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA [`NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA �0 NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [3No ❑ NA XNE
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 ElNo ElNA OkE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA /NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA VNE
General Permit? (ie/ discharge, freeboard problems, over application) _.,/
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? El Yes L,e No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? Yes /❑ No ❑ NA [I NE
Additional Comments and/or Drawings:
is 41- 0 7 & L&) ��f/�5 nJ �Z4LCZA ,, GOcv
2� P�� BAR �,� USES ��S�Q�� 7z-
-- ND t15� k ,Li✓ /�DvS� `-ell ✓d �� /�v
6-
Page 3 of 3 12128104

-, O'Division of Water: Quality
Facility Number � Z Q.,Division of. Soil and Water Conservation
--- -- - —:other Agency
Type of Visit VCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint XFollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �l Arrival Time: J f 20 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: bet1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• I A
Operator Certification Number:
Back-up Certification Number:
Latitude: 00
= 6 Longitude: = ° = g
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
k' ❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish - - -
❑ Farrow to Wean Dry Poultry:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other f
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: n
E --1
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 /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes XNo ❑ NA ❑ NE
❑ Yes No ElNA ElNE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? rQ 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: All
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 119
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes le
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Q No ❑ NA El
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ONE
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 ❑ No ❑ NA E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA VNE
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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA �JNE
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
❑ NAg NE
17. Does the facility lack adequate acreage for land application?
[IYes
❑ No
❑ NA �
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ 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):
G��no•� �Ozrk W4Z4
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Pa¢v 2 of 3
T� Phone:
Date: /
1212RI04 Continued

q� , t--,L--,�—,
Facility Number: 7:7-7Z1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA XNE
the appropriate box. El MVP Design El ❑Other
WOp ❑ Checklists
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 V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NANE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
T
❑ NA E
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 I<NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
NA
[I;dNE
Other Issues
' 29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA P 1_E
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA E
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
If yes, contact a regional Air Quality representative immediately
'PFNE
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
)dNo
❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA ❑ NE
Additional Comments and/or Drawines:
Page 3 of 3 12,128104

Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
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
� r
Date of Visit: 4V Arrival Time: 7i�� eparture Time: County: Region: i �y
Farm Name: ��, III Owner Email:
Owner Name: _ 'yL/Os��G�e? Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
/jPhone No:
Integrator• 19/ _A
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = & = Longitude: 0 ° 0 6
Design Current Design C►urrent Design Current
SwineI Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder 10 Non -Layer I I Dairy Calf
54 Feeder to Finish
Q
❑ Dairy Heifer
El Farrow'to-Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes )ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
XNo
❑ 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 ❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes gNo
❑ 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 oNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;2No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes VNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes YNo
❑ 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 ❑ No
❑ NA
ANE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. P es ❑ No ❑ NA ❑ NE
❑ Excessive Ponding VHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA '10 NE
15. Does ther'eceivi`n1.g crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ONE
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
❑ No
❑ NA �NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA XNE
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):
—0,�6_Q �� G�/�5 T� ��n/oLF �i✓,p b' ���z� GC%-S�,E
Reviewer/Inspector Name 1 Phone: v 3Z
Reviewer/Inspector Signature: Date: ?i
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection S -
Required Records & Documents
19. Did the facility fail to have 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 El Maps El Other
❑ Yes ❑ No ❑ NA X NE
❑ Yes ❑ No ❑ NAXNE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA 6 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA XNE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
❑ No
ElNA NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA I�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 Q�NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ONE
I
Other ssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NANE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
�NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
El No
ElNA
P(
}J 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
/VNo
❑ NA
El 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?
zYes
/R'No
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�%Of✓� �� �j��GzC�Trf�,J ,�
ri�iG� 1 f
Page 3 of 3 12128104

:,
Division of Water Quality
FacitityNumb'er. Z O Division of Soil and Water Conservation
— - — - 0. Other Agency
jType of Visit 0compliance inspection 0 Operation Review 0 Structure Evafuation 0 Technical Assistance I
f! Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rrival Time: Departure Time: County:
Farm Name: D f�o5 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Z4GL
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region: "- �l `
Phone No:
Integrator• %ri -A
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 4 ❑ Longitude: = ° ❑ 1 ❑
Design Current Design Current
Swine Capacity Population Wet Poultry . Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder Non -Layer
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Gilts ❑ Non -Layers
❑ Boars 1 ❑ Pullets
-- - — ❑ Turkeys
Other E] Turkey Poults
❑ Other JE1 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: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
12128104 Continued

s i
Facility Number: — Date of Inspection /y
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3
Structure 3 Structure 4
9yes ElNo
❑ Yes V(No
Structure 5
El NA [I NE
❑NA ONE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JLI No ❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.) /
b. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ 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 P(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?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE
❑ Excessive Ponding ❑ Hydraulic Overload [I Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No ❑ NA VNE
❑ No ❑ NA �NE
ElNo ElNA% NE
❑ No ❑ NA �jN
E
No ❑ NA E
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explainsituations. (use additional pages as necessary)::
Leviewer/Inspector Name
,L Phone: /Z Z
eviewer/inspector Signature:
Date: Z Z
Page 2 of 3 12128104 - Continued

Facility Number: — Date of Inspection
Required Records & Documents f
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA P�NE
the appropriate box. /
El WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ZNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA Vf NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No ❑ NA
NE
El Yes El No El NA
❑ Yes ❑ No ❑ NANE
❑ Yes ❑ No ❑ NA VNE
❑ Yes ❑ No ❑ NA �NE
El Yes ❑ No El NA �NE
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA / ZNE
El Yes XNo ❑NA❑NE
Page 3 of 3 12128104

<<
Facility Number i 2
® Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other ❑ Denied Access
Date of Visit: (► Arrival Time: ; a (1 I'W Departure Time: County: ?WPE& Region:
Farm Name: Owner Email:
Owner Name:" S G NAP4 t' � � NPLL- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c 0 t Longitude: =°= i
Design Current Design Current Design Current
Wine; Ca aci Population WetPoultry Capacity Population Cattle
p ty p rry p ty p Capacity �PWllp at,00n,
❑ Wean to Finish
i
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other'
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow I
R.
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ' ❑ Structure EVApplication Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
NYes ❑ No ❑ NA ❑ NE
❑ Yes 19'I No ❑ NA ❑ NE
1p"Y"es ❑ No ❑ NA ❑ NE
0
[-]Yes 5C ❑ NA ❑ NE
❑ Yes 5(No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

c�
Facility Number: Date of Inspection It d U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑'NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA []�NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑Maps El Other J
21. Does record keeping need improvement? If yes, check the appropriate box below. ElE Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA 7NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA fNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA �E2"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 [3/NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
Z% NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ErNE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
OKE
If yes, contact a regional Air Quality representative immediately
Yes
31. Did the facility fail to notify the regional office of emergency situations as required by
Q
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
El
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
es
No
❑ NA
NE
33. Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
I Y� LA&op:? t-t JCL of 1211 WM SC( N WXTH I a. S "' P05SLU3t_E., Nb Noi.t�,rC}�-f� -ro Dl�it�Q
or AXG-A r1wE6aAK1).
II,� ZN i~.L�c,o DsRr<c`t'L� ='Ij pLout eF' FbCt Gu_rcp!N6S 3CVG&AL. AoAAS 06ARV(0
GotnAzt0;Z74G wASTC At-oN G- WXTN -rNE FII L14 10 MrbOLC bF F.rELV
No 0VM(T f=60
WAS w g w-twu K- of to-o" -I`l B"wells 1, A s N�-i-F i-ED 0� SY`Cd A'fZG 1J ,
a� C�A,� 4:k'xc.t., CHcs-tep_ Cogg) -rook AVPXaPRTATC- SAmPc*S Nu9 i't.LTi act .
Page 3 of 3 12128104

Facility Number: — 7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? MlYes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes VNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1..A Croo d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I $
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes G? 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 dNo ❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA VNE
maintenance/improvement?
11. Is th re evidence of incorrect application? If yes, check the appropriate box below. [Yes [I No El NA ❑ NE
Is
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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
dNo
❑ NA
❑ NE
EdNo
❑ NA
❑ NE
No
❑ NA
❑ NE
U(No
❑ NA
❑ NE
dNo
❑ 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):
� � DY.SC.{d fl R.6i6 WA015. 1UgC,9 Lk %vXNG TfiC t'Ae*% PAC.ILT-Tu FrR.W -fW0 t-0 CATrAA,CS. DX-r(A
90W,IV36, Aw�JG 5ACKS::-LDE Of FSCc.9S 7,tJ l,00W AND 0_rMj Rvn/n1rMG A"NCG fACM
fLo q 0 WAS SEErJ Got"Eqs NG WASTE W A-rCp, 7o O T Tc14'S c.EA t«nlr 'FA R M . 3 oT+H PIGS
LE 06,1'l{ oC N ibu �T W �iC aRSEat-�6 O �t�i.J . ES-rt VtiA�E GILEAi+E 11 TkAiJ 1 ab G GAu.Or1S i6C--r
FA1?ON
Reviewer/Inspector Name 1 1Phone: (QQ) we, " i3R?
Reviewer/Inspector Signature: Date:
i use r 1 ... �rrrw yr a.vrsa.n wcw

Type of Visit 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforVisit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: Departure Time: County: P&J f-64&_ _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: [7Lr.. AUN 1A P`u/
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 0' =« Longitude: ❑° =]' =
Design Current Design Current Design Current
Swine Capacity P�opulat] on, , , WPrY "Capacity P6pnlatron Cattle Capacity Population
❑ Wean to Finish
iry Cow
❑ Wean to Feeder
iry Calf
Feeder to Finish
io
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
ElNon-Dairy
❑ Layers
❑ Farrow to Finish
El Beef Stocker
❑Non -La Non -Layers
❑Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Turkeys
Qther ❑ Turkey Poults
❑ Other ❑ Other
10 Beef Brood Cowl
of Structures:
INumber
Discharees & 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
FINE
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
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
VNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

•
Facility Number:.? 1 — 2
Date of Inspection l +S
Waste Collection & Treatment
ENo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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:yAs;oolJ i
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in):j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ 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
L3No ❑ 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)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
V No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�,�
Id No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ 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 Drifl ❑ Application Outside of Area
12. Croptype(s) e�edAJco, 6c9' S G6
13. Soil type(s) N a R & 6 A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E(,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes eNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El I-1 No
❑ NA
❑ NE
11) \061TCP AC4zCS C C-T c T S ►J 1-6 CZEVSS +` W UR
a(,) QMM=W ('" RAT-r-)(A1_,U zlv s�Ec-�s��� OCO TO 3(- 0�06 .
Reviewer/Inspector Name a l Phone: 5/0 i4
Reviewer/Inspector Signature: Date: -) !�
12128104 Continued

Facility Number: 7+ — -7 Date of Inspection 7 JS o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ es L� No El NA [I NE
20. Does the facility fail to haVWuP
components of the CAWMP readily available? If yes, check Yes [I No El NA ❑ NE
the appropirate box. ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
reeboard ❑ Waste Analysis El Soil Analysis El Waste Transfers
❑ Waste Application ❑ Wer1op,
❑ Annual
Certification
[I Rainfall El Stocking Yield [1120 Minute Inspections LGMonthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q'&o
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
El,
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
<o ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�/
E] 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
ElYes
2No ❑ 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
LLd-7o NA
El NE
33.
Does facility require a follow-up visit by same agency?
El
o ❑ NA
❑ NE
Additional Gatr►ments,andloYDrawings
12128104

Type of Visit 91 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9'Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit: L
Permitted 13 Ce i led © Conditionally Certified 13 Registered
Farm Name: ., — _ --
Owner Name: _ Q1J�,er_ .WLL __
.Mailing Address:
' z Tune;
Not Onerational O Below
Date Last OperatedAc Jbove Threshold:
County:... r��. A < . _ . .
Phone No:
Facility Contact: .. .. _ Title: .... .... Phone No:
Onsite Representative: —S a—�wilw &Iice rN integrator.
Certified Operator: - . _ _ _ _ Operator Certification Number:
Location of Farm:
Rf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • 4 44
Desig�i
ac ti r
_,Cnrreat >� � ;'Design � Ceirreat :.:
D�go �C
=Po Lion pQ�9 =... ci
{Po' Lion: Cattle
x
po tan
-
Wean to Feeder
�:
Dairy
r.
- Non
-Dairy
y
otal SSLW
Number'ofLagooas � �` �' � �`
�
_ .. 4w Y � 1. a- •_}'" � a = .� � �
^r. -e'- -. T � ��
t�
-
-
Layer
seder to Finish
Non -Layer
Farrow to Wean
Other
Farrow to Feeder
Farrow to Finish
� �`
Gilts
Boars
I §§dar ges & Stream ImLyacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: [I Lagoon [I 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) [I 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? [IYes j2 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 13 No
Waste Collection & Treatment
4. Is storage c
apacity_(freeboard plus storm storage) less than adequate? ❑ Spillway [I Yes RrNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): _
12112103 Controlled

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
�( No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes
j No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
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
;YNo
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 maintenancelunprovement?
❑ Yes
ONO
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ yes
ONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen nd ❑ Copper and/or Zinc
12. Crop type lj4q)
13. Do the receiving crops differ with th designated in the Certified Animal Waste ManagZment Plan (CAWMP)?
❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
JZYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ yes
El No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
SNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Z No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
.® No
Air Quality representative immediately.
€tJst drawiagS fad[tyto iiet ol'1S.'{arse adoaal psgrs r3'? ° ❑ l field Copy ❑ Final Notes
c�?) rg" _ tJ�Ls L 8 / a 1 C f 7607,
�%r#- ���n�s. A ICIL1� r��,o G�
6o C k T 147 -/ ,.J ,37/�Oxrs/"
f 3
/.�
Reviewer/1nspector Name
Reviewer/Inspector Signature:
Date: /Z/f.< /D
12112103 Condnued

Facilfty Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard J'Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ;3No
❑ Yes IZ No
0 Yes ❑ No
❑ Yes m No
25_ Did the facility fail to have a actively certified operator in charge?
Q Yes
0 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
e x c
(ie/ discharge, freeboard problems, over application)
❑ Yes
M&o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Q Yes
No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
OYes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Q Yes
ZNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JZ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
PrNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
gNo
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
gYes
❑ No
❑ Stocking Form ,0 Crop Yield Form ❑ Rainfall ja inspection After I" Rain
,ff120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Z3� Dr��� � � sr� �ArnPc�S T�rF,✓ �t5 Y�2 � F� �o���/ �rvo �s/�
"�� Gl%/�59E �I�PGzci47�o�5 �uYst,OFz DJG� �� �ov�,
9.vs �� �.��,�,o
Om 200�1_
CO.0 �6L /9QPGaG •g �z� �S,
/GRAA- aO
F7- /`t�vfr i4 1v0
3 N yee,,�r,7ge-F
j!2_2nas
r-,vo Du�aJ 2 �.
12112V3 GL Z s WA e 7" /tiL11_49S

0
19
Facility Number Date of Visit: Time: I 146 5
Not O erational 0 Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: County:_A.-c
Owner Name: tQ Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
ET -Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design
Design Current
Current Design CurrentMCapaci
Swine
.Ca acitv:
1',a ulation 1?�oultry _ Ca acity P,o-ulatiOn Cattty P,o ulation
❑ Wean to Feeder
❑ Layer ❑ Dairy
❑ Feeder to Finish
❑ Non -La er ' 10 Non -Dairy
x
❑ Farrow to Wean
El Farrow to Feeder
Other
❑ Farrow to Finish
. • a
Total Design Capacity
❑ Gilts
❑ Boars
Total S3LW
Number of Lagoons ❑ Subsurface Drains Present 1101,nizoonArea ❑ S rav Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discbarees & 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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Er_y_'_S�
❑ No
Structure 6
Continued

Facility Number. I — c-)— 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?
S. 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 Apulication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes [--]No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
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 fait to discuss review/inspcction with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
} o� .- + ,'•fit
Comm�ents5{irefer to;quest►on � Eaplam any�YEStr`answers�andJor any recommendahons..or any`other,comments.^
iUs" a drawiiigs facility to as
$ of better
eaplam situations: {use additional pages necessary) field C in
❑F Copy ❑ F al Notes
l�
��n J
x
�
Reviewer/Inspector Name
n.
Reviewer/Inspector Signature:
Date:
05103101 Continued

Type of Visit fO Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Eim Time: t 3' 0 0
Facility_ Number i
Not erational 0 Below Threshold
O Permitted 0 Certified D Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: PCV%A0rase. County: Pe Ada''
Owner Name: "Dn"1"` d I Phone No:
Mailing Address:
Facility Contact: —7� Title: Phone No:
Onsite Representative: L o n A) d 1 { integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' u Longitude 0' C�
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
❑ Yes /!!f No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes El No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ff No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ff No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Freeboard (inches): 33
05103101 Continued

to
• Facility Number: — %Z Date of Inspection ! 1 d
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �er.�-Lvdg i-��.y-5�-���( (era*'-► (�VB,�S2e0E
11 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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONO
❑ Yes 0 No
❑ Yes VNo
❑ Yes Z No
❑ Yes .TNo
[--]Yes ONO
❑ Yes '-2TNo
❑ Yes ZNo
❑ Yes ❑ No
,Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ ,�I Yes No
❑ Yes XNO
❑ Yes ONO
❑ Yes ❑ No
❑ Yes 2TNo
❑ Yes ONO
❑ Yes JZNo
❑ Yes Fe-rNo
❑ Yes JZNo
❑ Yes XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments{refeuto quesfiiie #) :Explain hny YES�answers and/or >}ny recomm dahons_or aov omher`ctimments o
Ilse drawings of:facility tv_better explasn sitnations:",:(ase atiiitnanal pages:as oecesss ) _ '
�- r3 ; ❑Field Cony ❑Final Notes
/�
�4k-s �qr,..� js LJei� JceF4. —rt r Sw!-ie house area �r
vleti��y ntioweA . ��eee if well es�a b!; stated . ^ v\of o-P 6,ee-, vviq .
Tile raclafds are o���h,'ZPp� Tl eve is ,I 'teed 40 hz e
we4g61C' ACre5 Ae4dm,-xg4teon �tl: �1. �1 ��t-�Gh,•-, wot SIC
'P 1 0,41, e reco'-d s r1e.Zd +0 6e kel:24 ALca�d r'n9! A1s,�y -�tiere
is t.to i..�c.s-fie a�alyS►S r�Poff Gtvq;lGt61e-��-.afi i 5 +,�;�7it;h �00 ct�•�
1 C +)
Reviewerllns ector Name
P +� c -
Reviewer/Inspector Signature: Date: l l g 02
05103101 Continued

Facility lumber: 21 -7Z
Date of Inspection ! o
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e_ broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 25No
❑ Yes Pi io
❑ Yes �No
❑ Yes �No
El Yes �Vo
❑ Yes ❑ No
Add itional`Comments andlor Drawings:.. f
G(a y s o-� '�-�-// Say-►-�C� quo p 1 i c a`} ; o " 1e v e °� s ? ct // e GG 1f�,� e,(
LA- rTUy�j4 2.Op2 j i'Vi�: 1-�� li Jhfnks 7�a� t e I,qS
q►�¢-��P►�' 0,�4 ��1;s -�L,�f '�t4 y GoJe� �esc eV¢nfs. �1�� se
��,� yeas or, 4ke Aet4es oA, 44c reco--d,r sa 44.efe L-�o,i 11 be
GO&.XF)_S o►\ 6tb0LA+ 41he Yec�✓r Gt'O1116441*o&n /C�CmiG�gj�✓eC6oz?ZA
T'CG"'Lj ,cZh.cl so 4ariLl .I A9a-'r ) -1�e i-r well kef4
�►+-�a{ ou-, er o,-4s 4o r��e�tar',� ;4 ;ji )cod Order Q/e
opt reGi'a 4�d . T� e 6e✓'� v i I,rl Crory ;S Luell eS4ct b i%s� ed �nvt
j S�rwt S;"'Ce �l y 1 A4- `/i T
05/03l0I

Facility Number Date of Visit: © Time:
0 Not Operational Q Below Threshold
Permitted © Certified 13 Conditionally Certified 0 Registered Date Last OperaWd or
Above Threshold: ........W.W .. W.
FarmName: ..... .G �!1.. .... County:....:k �4`................................... ...» ................................................................... .
OwnerName: ........... . .. . ................ . ................ ........................................................................ Phone No:.........................................
FacilityContact: .....................:........................................................ Title:................................................. - ......... Phone No:
MailingAddress: ..................................................................................................................... .................................... .............. ..................... ...W....._............_..._.
............... _........ _Onsite Representative:... ......... . .......................................................... Integrator:........ .......... ......
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 k4 Longitude • 6 46
Desigo Current = : >_ Design .-Current Design
.-., :Capacity . PopulatioW Poultry :; ..Capacity .Population Cattle :,Caascil
=>
❑ Wean to Feeder
eeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
:-
❑ Boars
Numbers o! Lagoons' ❑ Subsurface Drains Present ❑moon Area ❑Spray Field Area
:.
Hdcliing Pools PSoiid'Traps ❑ No Liquid Waste Management System = -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? .
[]Yes
gNo
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)
0 Yes
❑ No
c. If discharge is observed, what is the estimated flow in gaVmin?
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
d�rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
A�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
R14o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................................................................................. ...................... . ...............................................................................................................
Freeboard (inches): `3Q
5/00
Continued
on back

Facility umber: — a- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type . C%4
13. Do the receiving crops differ with those d signated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ict WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes *o
❑ Yes XNo
❑ Yes krNo
❑ Yes t5(No
❑ Yes 0 No
❑ Yes t`No
❑ Yes W No
❑ Yes R(No .
❑ Yes KNo
9Yes ❑ No
❑ Yes ❑ No
❑ Yes 9No
❑ Yes g No
❑ Yes ONo
KYes ❑ No
❑ Yes ONo
❑ Yes 9INo
❑ Yes KNo
❑ Yes WNo
❑ Yes KNo
❑ Yes RNo
❑ Yes XNo
q atiOris:o dtffcaehc10$ #'re )iWd- 00ift this'A"Iti • ;Y;o0 wits teb W6 flo futfte .. .
corres deike: about this visit`
Cam nts (refer to.ques#ion #) Explain any YES answers an any "recommendatiatxs or apy other towmenta7 . ��
Use draw;of fa%ilityto better explain situation. (use additional:page's as;iuecessary)v.„'
i � s
Ila
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 'a-- —{3 5100

Facility Number: T�Date of .inspection `
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Kyes; ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
❑ Yes R44o
❑ Yes dNo
❑ Yes No
❑ Yes
❑ Yes kNo
tigComments an or ra ngs:.
AL
UJI'l
AZ _y_ r
7
5/00

:z - .+)Division of Water Quality
. V
_V
_ Q Divisiori:of Sail and Water ConservatEon F
Q Other Agency' v .
Type of Visit 19Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up OE mergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: i L 1 S4d Time: I' V0S Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted (] Certified 13 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .........................
Farm Name: IN h AerOSC,_ County: elr...................................................
......................................................ii.......................................................................
Owner Name:. ---- �a h lad I"Ty. f ----------------- Phone No: -------------- ------- - -
Facility Contact:
Title:.,..,..
MailingAddress:.....................................................................................................................
Onsite Representative:mbna1w
Certified Operator:. ..................................................
Location'of Farm:
Phone No:
lntegrator: „•.,,•• Jr rMS
/�'1.....�ok � ...... a ...........................................
Operator Certification Number:,,•„
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • 4 64
Design Current
Wean to Feeder
eeder to Finish
3 q Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Namhes of Lagoons ❑ Subsurface Drains Present ❑ Lagnnn Area ❑ Spray Field Area -.
#adingPon& / Solid Tr4s .. ` ` ❑ No Liquid Waste Management System _
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ❑ 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
Stru -lure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:...........................................................................................................
Freeboard (inches): 341
5100
❑ Yes No
❑ Yes XNo
❑ Yes P No
VI fiQ
❑ Yes 19 No
❑ Yes it No
❑ Yes wo
❑ Yes 10 No
Structure 6
Continued on back

Facility Number: Date of inspection 1 1 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 ko
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'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 17 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes V No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )jNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,;ZNo
11. Is there evidence of over application? ❑ Excessive Pondiing [:] PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type 13 er e t Vd R '0.Z e, , S;"A fH �r`r�i �►..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,� No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
25Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
No
(ie/ problems, over application)
Jba
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O 'No
l'VQ vi0lait6lis;er• dkflciencles •mere noted• during this *visit' Y:ou will •reeeive iio tu. thef. ;
-oriespondence: abowf this visit:
Comments (refer to question #)c Explain any YES answers and/or any iecommendations.or:any 'other comments -x ;
Use drawings of facility to better explain situations {useWadditioia)
l<pages.as neces
'1
�. �rrC +��' (Gt;�n t..�0.��r iS 1't� p-n-�e��'�} 1�7t.�,S�s/��faDO� G1►'t0�, �
19. Need f e,_sl r e-aK4 c3eve—rqrerrrt, Q►'lam Wy G� Q7! i/1GS ZOA3j
0. Fu+ -# ie Qftr oyi �[ t recercfr 4o e1:,,,,,,,,cA-e rot�rf`�T0n. -rgke a
L-.JA34-C Sa fte even- 'S Xan�e, leae, - Use, a1,a[7s,f'4a�'-"a �.,/;+kI ',
ce4
hod `� _r are P19#,sc� .tw
o1- oK-44e sKR- z-tar-Pr, Use 6e ;Vtam+
A VG 6 Aj 4V-0tiCVX 4 I tot q KC -rroln 44c wa-s4c- Ptq►, ott
Reviewer/Inspector Name ; e tnrFl I j o f A; 1.
Reviewer/Inspector Signature: Date: r S' DA sroo

Facility. Number: ►71 - r] Date of Inspection ) 5 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 Wor below Yes ❑ No -
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P' 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 J4No
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 ;ffNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
AdditionaLComments and/or rawings:
I�
We- 4c 4cees de,�- /+�t'1r(�Lo[ Jt1`oh W�IiG� /'• f7G.l(
-
t�. road Jer,-rf w eed t
1V'4G : )O V f a C Ov ew-aVI +ke d e^Ot b;n •
] �+�+ -{
NO �row�r S L}1 (.JheaJ CVcfseed 1y -�'aktl, Ogt"T c/C��'1e�•
f 1 ,elk dQ►-►..t, e 'betrmva(vs; y ads ► -�averse-eA
�s1P�d1.
�O A ll/o 6,0� a'"'��i °J � ►�9j T x �' 4ldR � r
J S � a b� ,�- v V ed 74 l po"' I U[
c.o o f e. � S GDYV 4 e, - ech e ed sf ee,' i'A a b v u4 A e✓G jG ✓a. S t
hi-�-�ooJ�h ctjlo.s ,.��nGe oh �ert^�t.vt�q, -�o a►G LOl't, Yl 'ro ✓ I O S!�
5100

Facility Number Date of Inspection a
Time of Inspection 1 SS 24 hr. (hh:mm)
Permitted [] Certified [3 Conditionally Certified 0 Registered JE3 Not Operational I Date Last Operated:
Farm Name: ................. ........e. .g S i Countr--
IAe Y1 a( c ✓'
........ f
Owner Name: -D o n1Oi I a( _)} ej tl j Phone No:
Facility Contact:
Mailing Address:
Onsite Representative:..........
Certified Operator:
Location of Farrn:
Title:
Phone No:
Integrator: kll U� It
Operator Certification Number:
T
Latitude �' �� Ct- Lon=etude 1—i` E:::a
Design Cur, Design Current Design Cnarresa
Swine Capacity Puts Lvi m Pouitrs Capacity Population Catfle capacity P -ua
❑ Wean to Feeder V L-Ye- U I Dairy I
❑ Feeder to Finish rL3 Nan-L�►Or j `on -Dairy I I
�] Farrow to Wean I
❑ Farrow to Feeder
❑ Farrow to Finish Total Design Capacity
❑ Gilts #
❑ Boars I Total SSLW
Number of Lagoons i Subsarf m Drams Prat RD Lagam Area ❑ Spn, Vx�d A,= I
.Holding Ponds�l Solid Traps ( + { -No Liquid W2ste M-2ement Svstem
Discharges & Stream Impacts
I. Is any discharge observed from a:ri• Fim of lihn- o=tian" © ves i ;iek:,
Discharge arivinated a,-: = r fa= ❑j Ste- Fi±i ❑ Ott
a. If disc- it is o_i�. as a tie: =,mzt- anct m2 mad<? ❑ Yes EIJPN,�
b. If disccaa~= is umcr.=f did h =x:h ;ome cf the Sate' (If rcs. ncafv DWQ)
c. If dischargY is t k v -hm i-, fw es�d flea in p1him'
d. Does cchaTr- iypz-� a lagn m sa to ? (II res. =nifv DWQ9 `ram a `tG
2. Is there evidence of past discharga frm m?, =- of tb= �'�w;! O fre_-� EDON ,
3. Were there any adverse impacts cf tie &:= cclt= zan from a arstigrg-_? C�) Yes;
Waste Collection & Treatment
4. Is storage capacity (freeboard plus sltrrm st r. Assn' ❑ 5,59�ay
Structure 1 t cur 2 5mr,-_= 3 5uis--. e: swar=ut 5 :.txu -urn -C-
Identifier: I
Freeboard (inches): .........& 5
5. Are there any immediate threats tie_-srtr_u rs 6bservcd9 l=J ts=r. sc cac �nsiost ©tom; ,�,�1
spa etc_ y
3/23199 C6xgbarucd Mc sw-i�

Facility Number: 7 f — Z Date of Inspection
71 OQ
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10- Are there any buffers that need maintenancelimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is therea lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
IT.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) .
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22-
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
?' O-*ibla(ioris'or di fieiendes •vt re itgte during �his'v1sit: YobAl i•eceiye Rio further : .
correst)otideike: about: this .visit: .........:.:....................... .
`2 � s p e G-�->`o►-� � on d v G-�- e o� ; ►�t �'� s e �.s e -�d +� �-� w 2 s -� y P � c o•wt� i a ✓► � e
LJas bc;'�,� s��^ayEd t,1 i,ioOd S , Nd PV: G{¢-t-GP or L JAJle ;n W Iods
was ou ►'�� 14 44e- 4), "e o-i : ►. s�e-c-lion .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z q Op

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 71 72 Date of Visit: 7/14/2000 Time: I6:55 Printed on: 8/15/2000
O Not Operational O Below Threshold
® Permitted ® Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _ __ __ .... _.
Farm Name: PQmderoa........................ County: Ptxkdcr.................................. .. S IR0 ......
Owner Name: I)Qnald........................... Han ........................ ------------ --------- Phone No: 9.10:.05A.473 --------------------------------------------
Facility Contact- - -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- - -- Title: _ -- -- -- -- -- -- -- -- -- -- -- -- -- - Phone No: -- -- -- -- -- -- -- -- -- -• -- ..
Mailing Address:.kfl5.HWy.133....................................................................................... RQ0W.YPIUAC ................................................... 7.8.5.7..............
.......................
Onsite Representative: .................... ............................................................ Integrator: �i3JUCl?11x.k�lllJ�l'.)NQ]fIDS_•-----•--•--------------•---
Certified 0perator:jjgrljkld_14, Hall _ _- Operator Certification Number: Xfj453
Location of Farm:
>outhwest of Burgaw. Located on North side of SR 1401 about 0.25 miles East of SR 1402. +
t
r
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude E 00 u Longitude 77 • 59 45
Swine
❑ Wean to Feeder
® Feeder to Finish
3672
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry _
❑ Layer
❑ Other
Tot
,Number°ofLagoons' 1
Holding Ponds / Sohd Traps?
Subsurface Drains Present JJ❑ Lagoon Area I❑ Spray Field Area I
No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ I................. ...................................
Freeboard (inches): 65

5100 Continued on back
Facility Number: 71-72 Date of Inspection 7/14/2000 Printed on: 8/15/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
)ection conducted in response to a complaint that waste was being sprayed in woods. No evidence of waste in woods was found at
time of inspection.
Reviewer/Inspector Name 'Sto.newall Maths

[� Diiision o: Soii and Water.Cori_sen ition: Ope.'ration Review
x Q Di►zs�on of Soil and ater-Coasersation Compliance inspection'; J i '�' x=
Division of Ater QuSlltj'-_COIDpl12FjCe �ILSpt [c- 911, : ��
-,.x �.___ .�1 •" -�-�� { may-
Z - r-- 13 0thFK A.��exr-y pera
�O �J fa c sy'I:a '�.�-r'.,,_' s.,�+.�•�.�� :i-:�_'tY`ie:
_ Routine 16 Complaint O FolIow-up of DXVQ inspection O FolIo..v-up of DS%C re'%jew O Other
Facility Number `7 t Tj Date of Inspection
Time of Inspection 1(.,SS 24 hr_ (hl;:mm)
❑ Permitted Q Certified 0 Condi6o=Uv Certified 0 Registered M tiot Operational Date Last Operate-":
�� e r^O S r, County: �'e ?-J j { c ✓'
Farm Name: ............._...__..:-•� .' ._...�_. .. _ .
Owner Name: n ►-�a, 1 c� !-�l1 Phone No: _
Facility Contact:
N--ailing Address-
Onsite Representative: ,-, --
Certified
Location of Farm:
Latitude =- [=:D' C-
Design CIIrre-=t
Swine
E
eaEo eeder
eFinish
❑ Farrow• to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
i`itie-_
Phone No:
Integrator _ Y" 1 U tr )G b
�I- (
Operator Certification Number:
Lon4ini&- L '• �_
Desizn Current Desijm Carvnx
Poultry CavadtT population Cattle Capadtt PoaajatitM
Dam: I J
N ' �. I I IJED 'Non -pair: I I
Total Desi�p Capacity -
Tow SSLW
utx,�rfxz Drams Pret -
Number of Lagrrons ,
i I C' - Er La.-ao+n Arn Spm-y. F-r-= 'k.—`(
Holding Ponds / Sol id Traps I `o Liquid ti3-2sx-- �haa-en=r Syst=
Discharges S Stream
1. Is any discharge observf-d from ant O: -=n
Discharm- ori?nalt'd a- L --vm t+
B. If dis_bm is ate-% th: =.rr:•-2n=
h. G dis::== is :ram: i5± it :--h =: x th- S:3iz' {I? _sate, Di'a'Qr
c. U disc: !t is — -ui� in' z fig- i:-) '-
d. Dees is :arc - rn-� z uz (I_ z-=L aaf- DW ---f Y'
2. Is there evic,nce of past disrisarge
3. Were there any adverse imparts c_ p-)-nit:=
Waste Collection d Trearment
4. Is storage capacity {frecward plt:s sztrni s1-r.2--: �!, -fz >
51r�rt'«r- l 5E7L=-1t"« 5
Ide:nlil:tir:
Freeboard (inei .%; ): ...... 6"5 - - -
5. Are there am• immediate' threats toil tttt_^r.t�• r"atnl Yir riss r �bs�-_�' tsrf try 5`-7e 'sires.
31? 3/99 ba`"

LacWty Number: 7 / — ? Z 1 Date of inspection
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 maintenancerimprovement?
8. Does any part of the waste management system oth-_r than waste structures require maintenanceiimprovement?
9. Do any stuctures lack adequate, gauged markers Kith required maximum and minimum Iiquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanc-c7mprovement?
11. Is there evidence of over application? ❑zsivc Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes C No
13. Do the receiving crops differ with those design in the Certified Animal Waste ltit�.2<�ement Plan (CAVV_M?)? ❑ Yes E:( No
14. a) Does the facility lack adequate acr=Lm for ianc 2pplicarion? ❑ Yes 0 No.
b) Does the facility need a wettable air d=== it=. inn? ❑ Yes © No
c) This facility is pended for a wettable =i-*-- ton? ❑ Yes 0 NO
15. Does the receiving crop need impro'%vm '
❑ Yes
0 No
16. is there a lack of adequate waste applir.�ou egu* n=nt?
❑ Yes
E tic
Required Records & Documents
17.. Fail to have Certificate of Coverage & C=~+ 7.=h rwdiiv available?
❑ Yes
`rNo.
18. Does the facility fail to have all compoa = ar M-- C_--sued Animal Waste a%m -gym"
(ie/ WUP, checklists, design, maps, e=)
=1 1 Yes
F�� Nc.
j 19. Does record keeping need improvem-.m' fr:-,board, v ste znah-s�s & sz@ maple zeporsy
❑ Yes
NO
20- Is facility not in compliance with anv , - � --. ' sera: k criteria in effect at the :icac n ?
❑ Yes
C NO
21. Did the facility fail to have a actively .= o;==mr in charge?
+ 1 Yes
L+vc:
22. Fail to notify regional DWQ of ern-==� s as r..qum:d by Gene.-zl Pen?
(ie/ discharge, freeboard problems, oval =)
� i Yes
C ticF
23. Did Reviewer/Inspector fail to discmm.--sr won Kith on -site repr-sue'
Ei Yes
rD-NC
24. Does facility require a follow-up visit 1w z� ?
Tit Yes
D N6
25. Were any additional problems noted -wi� =3n==Iian= of the C_� A-o--WU'
Z + Yes
C tiFa
----------------------------------
�'Vo yialat�Qtis:e� def e....... n ,x 1 s:visiti - — �l e o urthirr -_-
'comes' o denceabatitthissi ---=-� -- ----------------=---=-_-:-_--:-:-_-:--_-:-:-;-:-:-.-:-:-.-
se ilra !ings Qf �faciiity:to-hefter expEai sddiiiui pagesas "�- =_ - '�' •' -
r� :�� ems•; r+- .� _- — �.�-- - - _' ���:,:.r��
Gnnd va�e..� r.., fa,nfse
tj QV,f�Er-6-F iL '
)�r,�j�r=
Reviewer/Inspector Name '- __ -
r` '* = - � = .1_ - -
,.
Reviewer/Inspector Signature: _ Dat-. 112 q 7.7G

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 9 k -'1a
Farm Name: Ta�i.qC^,
On -Site Representative: Gam.
Inspector/Reviewer's Name:L'�—���
Date of site visit:
Date of most recent WUP: �� cL5
Operation is'flagged for a wettable
acre determination due to failure of
Part 11 eligibility items) F1 F2 F3
Operation not required to secure WA
determination at this time based on
exemption El E2 E3 E4
Annual farm PAN deficit: pounds
Irrigation System(s) - circle #:®hard -hose traveler, 2. center -pivot system; 3, linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system W/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part If - F1 F2 F3, before completing computational table in Part 111).
PART If. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F'! Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
bufferlsetback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
J F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised January 22, 1999
Facility Number
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBEW-2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
n `f
I t0a
Q
3
1
a,Dcl
a,
f
_
I
FIELD NUMBER'- hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBERZ - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

— _ ©:Division of Soil and Water -Conservation -:.Operation
;© Division of Soil and, Water Conservation - Compliance Inspection
w
0Division.of Water Quality - Complinnce Inspection
-^ � Other=Agency- Operation Review
J;kRoutine 0 Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
Permitted © Certified ❑ Conditionally Certified ❑ Registered 13 Not Operational Date Last Operated:
Farm Name: ...- C} 2vOs ............................ County:............. e,--^�2✓................................... ............
Owner Name:.....�Q � \� ----•................ Phone No:...................
FacilityContact: .............................................................................. Title:................................................................ Phone No:.................................................
MailingAddress: ......................................../...........1........+.....�................................................................................................................ _.....
..................
................
Onsite Representative:. ....L... .! .. 44:L1............................. Integrator-... .. C......................................................
f
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
I ocati n of ri :
Latitude �• �< CJ" 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
1EE]
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ LatGoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imt3acts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other -
a. If discharge is observed, was the conveyance man-madc`'
b. If- discharge is observed. did it reach: ❑ Surface Waters' ❑ Waters of the State
c. If discharge is observed. what is the estimates( flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
tr
Structure I
Identifier:
Frceboard (inches): ............ .... ........................
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes VNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 11(No
❑ Yes % No
❑ Yes XNo
Structure 6
1/6/99 Continued on back

FaNity Numher: — 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 pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? y
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
1- .. ....I..... s . (� �...................... .
12. Crop type .................................. .
0
❑ Yes �(No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes N No
Of Yes ❑ No
❑ Yes No
❑ Yes [XNo
❑ Yes � No
❑ Yes (9 No
❑ Yes � No
❑ Yes VNo
❑ Yes XNo
❑ Yes NrNo
❑ Yes 14 No
DdYes ❑ No
D4 Yes ❑ No
❑ Yes XNo
❑ Yes M No
❑ Yes tZ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0No
24. Does facility require a follow-up visit by same agency? ❑ Yes rVNo
❑: No.viala'dons.ot: deficiencies .weire rioted. during liiis.visi ;'. You v'd*11.reeeive no further . .
• co respbiidence; about: this ;visit.; • ; - : - : • : : .
Comments (refdr- to question,#): Explain any YES answers and/or any recommendations.or: any,other. cominents d�`<
Use.dr"a*ings of:facility to better explain situations. (use additional pages as necessary)
Reviewerfinspector Name
Reviewer/InspectorSignature:, _ Date: [ i11q I1/6/99

Flrcility Number:. .L..... -•-.. .: Date of Inspection:
-AdditionalComments. and/or Drawings.
WA- , XN \ G s c� T1,0
G�, �i�1g t r•►=t5�� t�L. sec + � Ts w ,L �O
W �G� �i �A i s- Vw-�- . �
� Lek 04 �� g'�'-�
aye '�, +sec SQ �� �-e�w l� lb
VL-t
LA\ 6GUQ►-a.. - - �
4/30/97

13Division of Soil and Water Conservation 0 Other Agency
13 Division of Water Quality
® Routine O Cam hint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Date of Inspection 3-Z3 '
Facility Number
Time of Inspection �Q 24 hr. (hh:mm)
Registered Certified © Applied for Permit �Perniitted JE3 Not Operational. Date Last Operated:
Farm Name: "�....
d d e.� QS Countv.�'+ y
Owner Name: ............... ...... t4G..(1.......................................................... Phone No: �14...1u.. � -O L(�3..............
...................... .................
FacilityContact: .............................................................................. Title: ............ ...... ..`.._......... Phone No:
Mailing Address: `I 6 (�..... ...4 ......1...3.3............................���KIT �' ,, Z.. .. . .. ................. ..........................
..........................................
Onsite Representative: ............................................. Integrator:.......t.1.�^ ...........................
............................................. ........ ... .
Certified Operator:..........C�...�.......�4.!....................................... Operator Certification Number,
..................
Location of Farm:
Latitude 0' ' 41 Longitude 0 ` ' 46
❑ Lean to Feeder
Feeder to Finish
36 Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design, Current
❑ Layer
❑ Dairy
❑ Non -Layer
❑ Non -Dairy
❑ Other,
r_
Total Design Capacity,
Total SSLW
General
1. Are there any buffers that need maintenance/improvement?
2. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenancetimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes �(No
❑ Yes KfNo
❑ Yes j (No
❑ Yes i'N0
❑ Yes gNo
❑ Yes IdNo
❑ Yes []No
El Yes <$fNo
❑ Yes OT
❑ Yes PJ No

V acility Number: -_� I — Z
j 8: Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes VNO
Structures (Lap-oonsMoldine Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
...................................................................................................................................................................................................................
Freeboard (ft): ......... ..........................
..................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes VNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes VNo
12. Do any of the structures need maintenance/improvement? I/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 ONo
Waste Application
14. Is there physical evidence of over application? ❑ Yes 'RfNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .........� ` '`.r.. ..........•••-•............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes VNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
PdNo
18.
Does the receiving crop need improvement?
XYes
❑ 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
VNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
gNo
22.
Does record keeping need improvement?
Yes
❑ No
)F'or_Certified
or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
NfNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
OdNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
0No
0•No.viailations-or. del"idencies.were'noti d-during thkvisit.- You:r�"rill recei' e-�no�ftirther
correspbndeb& A out this:visit'.
�COI'ninentS�re�er t0 questxr►n�1l�Explarn a}nyY�+�gan���pwper�/alllt�ll{�Ur any pr�eCOln1n/ie�II�i�lp9tlflnS Or 8IIy O�IfeF C©<IIir�eiitS� �"' -
�V n• �1lNw�n�,.3 ���Y�fiY� tY RI�.V�il e�,`Alln.�LiFR�W�3.-�e(Yw�F �diai��F� W aS i�41.4��Y�y�� �` yc'�� 3-0 � f. Y3'�'� i. h..
ry
'�c1�.x...,a,',�d'�'E.<!c-.�,•.N»�, „�,#m' � �<f1w`, -: -..." t.1Xi4L4FFk .re4'�% �F. .. si�E�..:v..J ', §; ec� ems.. ,�.' .'� C-
J
12., RL ,4vest4 c Lie— a -zz5 ­ffrcv.. i,/- )c,$Ov t�l
�
L ccVorG/c/4
27 Itta(} -It cOV7 p� 6 1�/`6 y S.y Ghs,
�j�✓7 �c/Gt Zoaar� !"L4�lCl S. G�" �a i T�
7/25/97
F
Reviewer/Inspectorr Name -
Reviewer/InspectorSignature: Date:

0
16 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection T -
Facility Number ,
Time of Inspection a 24 hr. (hh:mm)
- Farm Status:Total Time (in hours) Spent onReview 0
...._�..�A,.�.1 �,.� `�� _......_. _....-_�...W W
or Inspection (includes travel and processing)
Farm Name: _-�� E�. _. ... .. -. _� ..»WWW_ .» County: ,lVL7 ..._..._. -__ ........
Owner Name:._ 4pinCG.IY .. _ Et C W L _. ....._____-- Phone No:.____
Mailing Address: . ------- ___ .___-________
OnsiteRepresentative:
Certified Operator..-_-------_.--_ _ _ Operator Certification Number.._. _. .._.
Location of Farm:
Latitude Longitude ' •10
Not Operational Date Last Operated: ------ ......--------- ___ _ ______— --_____-_,..__...-,^_
Type of Operation and Design Capacity
General
1. Are there any buffers that need maintenancefunprovement? ❑ Yes JM No
2. Is any discharge observed from any part of the operation? ❑ Yes No
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 D W Q) ❑ Yes JU 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 48 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ZINo
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 09 Yes 16 No
maintenancefunprovement?

6. Is facility not in compliance with any applicable setback criteria? — _ ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1 /97)? ❑ Yes No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes GtNo
Structuresff:! og nsand/orHoldingPonds)
9. Is structural freeboard less than adequate? ❑ Yes VNo
Freeboard (ft): La oon 1 Lagoon 2 Lagoon 3 -- Lagoon 4 --
.__4____
10. Is seepage observed from any of the structures? ❑ Yes 54 No
11. Is erosion, or any other threats to the integrity of arr of the structures observed? EQ Yes ❑ No
12. Do any of the structures need maintenancefunprovement? (k] Yes El -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 adquate markers to identify start and stop pumping levels? ❑ Yes Z No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or nmoff entering waters of the State, notify DWQ)
15. Crop type -------------- _1 44wom �
16. Do the active crops differ with those designated in the Animal Waste Management Plan? ❑ Yes ® No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18.
Does the cover crop need improvement?
❑ Yes
PLNo
19.
Is there a lack of available irrigation equipment?
❑ Yes
J4 No
For Certified Facilities Only
20.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
Yes
❑ No
21.
Does the facility fail to comply with the Animal Waste Management Plan in any way?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ Yes
® No
23.
Does facility require a follow-up visit by same agency?
❑ Yes
No
24.
Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes
X No
Reviewer/Inspector Name
Reviwer/Inspector Signature: Date:

Site Requires Immediate Attention:
Facility No. ^-7 Z_
DIVISION OF ENVIRONTMENTAL MAINAGE.MENT
A_\ZMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - 2 0 , 1994;
Time: 2' v 3 v s- a<(73
Farm Name(Owner:_ Ikon} 6 eza�l 5 A r A i-M
Mailina Address:. _ i_661 l S 1441 �1 ­ 3 3 A21:�1-2-&- f 4 1?d r , a 2- %6 Y'-�
County: ?i:-- ' > � �- - - -
Inte?rator: y •ni - o 47- Q b--i Phone: 0 Z ft y z < < 9
-Siepresentauve: �Yud' ��G�T �� ir��� Phone:
Physical Address/Location:
Type of Operation: Swine _.X_ Poulri-y Cattle
Design Capacity: 3 .7 Z Number of Animals on Site:
DEM Certification Number: ACE DEMT Certification Number: ACNEW
Latitude: 30 a l� Lon rude: �7' _' -tS 2 Elevadon: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient Leeboard of 1 Foot = 25 year 24 hour sto==n ever:
(approximately 1. Foot T 7 inches) � or No Actual Freeboard:_j__Ft. -7 Inches
Was any seepage observed from the lagoon(s)? Yes oriD Was any erosion observed or No
Is adequate land available for spray? ( or No Is the cover crop adequate? Yes or,&
Crop(s) being utilized: 50VIl S
Does the facility meet SCS minimum setback c;_teria? 200 Feet from Dwellings? )0or - No
100 Feet from Wells? ISIr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Snam? Yes ordD
Is animal waste land applied or. spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orb
Is animal waste discharged into waters of the state by than -made ditch, flushing systern, or other
similar man-made devices? Yes or(f�:) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray imgated on specific acreage with cover crop)? Yes or No
Additional Comments: G Leh I-e R l � .�� G��v �•�.
Inspector am Signature
cc: Fa6liry Ass:.ssment Unit Us.- Attachments if Needed.

Site Requires Immediate Attention:
' Facility No.
DFVISION OF ENVIRONMENTAL MA -NAGS -IN ENT
AN MAL FEEDLOT OPERATIONS SITE VISITATION RECORD '
DATE: _�_ 2-y , 199&
Time: 2 ' v� jv (,e7 f` O k73
Farm NamelOwner: �oN D_ ti 5 / r A Q r+1 - j>d /04 LZ$ )-f ACL Q r`)JD
Mailing Address: 144-t03 ,� - 2- if Y 1
County:
Integrator 1M tI�Z p �`� - � Phone: t'6 100 Z T 4
9n. epresentarive: Phone:
Physical Address/Location:
Type of Operation: Swine _X - Poultry Cattle
Design Capacity: Number of Animals on Site:
DELI Certification Number. ACE
Latitude:
" Longitude:
DEM Cerdncadon Number: ACN-EW
Circle Yes or No
" Elevation: Feet
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot 25 year 24 hour storm event
(approximately I Foot + 7 inches) 92 or No Actual Freeboard: L Ft. -7 Inches
Was any seepage observed from the laaoon(s)? Yes or-D Was anv erosion observed or No
Is adequate land available for spray? or No Is the cover crop adequate? Yes or,4g)
Crop(s) being utilized: Y►ti054-14 U,4,e"Q S- -
Does the facility meet SCS min;mum setback criteria? 200 Feet from Dwellings? XPor No
100 Feet from Wells? r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Strum? Yes org
Is animal waste land applied or, spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orb ��-
'Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or�o If Yes, Please Explain -
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray ir3rigated on specific acreage with cover crop)? Yes or No
Additional Comments: 1,A j gr^ a ;,L x t //y�v� � 4 Gl� v s.�« A _ .
<iI iQ M f'�G 1 Dl el ✓Te 1,
Insucctor 14amelSuture
i
cc: Facility Assessment Unit Use Anaclirnents if Needed.

F
1
I
\
h
1 � r
r 5-7
r
Ile
1

nfe�a�`55
V1� V."' 6� �SS,SI�Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ �.-A , 1995
Time: ) 4-0 0 0.; SG., I-1.
Farm Name/Owner- atMaL� kkr-L� I PU"e irOScA_ (Q PD )
Mailing Address: l S- �`� L4:1 33`
County:
Integrator: � u v9 I Phone:
On Site Representative: ��-�� ��-� _ _ Phone:
Physical Address/Location: _ CS (L 1 40
S YZ- l L1 U 0
Type of Operation: Swine `� Poultry Cattle
Design Capacity: Number of Animals on Site: 4• 3 C� C�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° 3 6 'ItLongitude: _n° 379 _` Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approkimately 1 Foot + 7 inches) Yes r No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C� S "
IryLS.L. T 6"cev- 5-f le -
Does the facility meet SCS minimum setblck criteria? 200 Feet from Dwellings?G�br No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o<9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o oNo If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated'on specific acreage with cover crop)? Yes o No , A
Additional Comments:
Inspector Name.
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.