710089_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: o ance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: !j Z Arrival Time: Op Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: // Title:
Onsite Representative: C hr•'3 pe t
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design C►urgent
Capacity Pop.
Design C«urgent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
p
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. P,oult .
Ga aci P.o P.
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q' o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ YesFJ'No ❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili '' Number: - Date of Inspection: PF 0 Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes EErNo ❑ NA 0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health oren ental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require D Yes �oo NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA E NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E]-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Efy-es ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No [DNA &NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Y
❑ No
CE!No
❑ NA
NA
NE
NE
18. Is there a lack of properly operating waste application equipment?
❑ s
❑
❑
R_eauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑
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 ElDesign ❑ Maps ❑ Lease Agreements
❑Ot r:
21. Does record keeping need improvement? If yes, check the appropriate box below.
OYes
❑ No
❑ NA
ONE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
D Weather
Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Slud a Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
Page 2 of 3 21412015 Continued

Facili ' Number: 7 - Date of Inspection: LO
24. Did the facility fail to calibrate waste application equipment as required by the permit? 7Z�14=_
7es
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check d ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
0 Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 6<A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes L, To ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 131 rv�
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9' o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesZ,<'o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? r24es ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
9 04"7-C e--J:kti�kr • 5
��a`t_ p�'�•p^ n C rose A. CP-4ac Sar��k�� pia dACItP,
won 41�+u �.
lew
tr� C�-V �,e 4.,,1
Clean date- 1.,4
fV- -'A 4,4 1 (-%. j or-,r-,
.s C� o, CS II C¢rH1n j
r. a 9 ' � S ON `C [20 19 1� 5 (�
1� e�- C9 P y p 7 ��•'f_ Y vl� ♦ i\GCD�GS 0, C
L a { 1�` 1 41_4e_ A&Y rr &JCnS el'L-- S4A> s or r-onC cans.
�u � ��-�- ward .S
fP 770 2-16 /Ir�eA
%�e n rn,c , I -7�1 & 73 &
�4s%") 7�'r'C'— '.6 e_—urI DL44/1 -- z-C-z ?k>� 3gop
Reviewer/Inspector Name: MAIV 1 � to 'A4
Reviewer/Inspector Signature:
Page 3 of 3
"p* 0k^%
AUM As�qln<«
Phone:
Date:
21412015

pri
Facility Number., �} I
Type of Visit (5 mpliance Ins ction 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitW WRoutine Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dare of Visit: �/ 7_1 p j� i Arrival lime: % 3 b Departure Time: Count"': �EN��� Region:
Farm Name: Owner Email:
Owner Name -
'flailing Address:
Physical Address:
Facility Contact:
Onsite Representative: _ QdflOqlkm)jG
Certified Operator:
Back-up Operator:
Location of Farrar:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
❑ Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑O ❑� ❑u Longitude: ❑0 =1 ❑ U
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non-Dai
❑ 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 (galions)?
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 1' I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(
❑ NA
❑ NE
❑ Yes
rZoc
❑ NA
❑ NE
12128104 Continued

Facility Number: I I —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stnicture I Stnccture 2 Structure 3 Structure 4
Identifier: Li G, -0$l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2/
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure S Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes O No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L No ❑ NA ❑ NE
maintenance or improvement?
Waste Application , ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenancelimptovement?
11. is there evidence of inconect application? if yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
.6No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
f(J Yes
El No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
€2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2_(No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ld No
❑ NA
❑ NE
.Comments (refer to question f: 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):
j,X&ECTF% �'.t�Cns ANC t.nc,-rf >! Foit Dar t6LE a- Ci4W9-UJ6 of 6F"�
V±D(_,+JC6
Reviewer/Inspector Name `f A/ 6 [ (, Phone: ill) _11474i3
Reviewer4nspector Signature: 44ddzY Date: d— -7 6d

Facility Number: — Date of Inspection 1 Sr 7_►025 I
Reguired 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design
g [I 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 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?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ®fOo7pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Q/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $ S o5 Arrival Time: ® Departure Time: County: %:IEUh! Dt✓IL Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: QA*:k� - U
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: = ° = ,
Design Current
Design Currenf Design Current .
Swine Opacity P�opula�tionf
Wet Poultry
„Capacity sP-opelation' ` Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish
S O
�b
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ ers
La
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
�i
Other,
❑ Other
❑ Turkey Points
❑ Other
� it
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
1-1NA❑
NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
El Ye
,❑3No
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
I No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — g 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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: GA6 vv0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or environmental tthh eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) j'3Cm_t^^ u0A L 4) 5,90
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? E es E o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes E<O ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes T Nb ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑/No ❑ NA ❑ NE
16 �. C-t_ps Q4.(_-p.5 WEC,F� eoNQrzAL �� a�TG-f� G2,►�ssc-S,
Co" S L oo
ector Name o; h �Q Reviewer/Ins
P J4t-� �. Phone:
Reviewer/Inspector Signature: Date: h 6S
12128104 Continued

Facility Number: '} ( — Date of Inspection
Required Records & Documents ZNo
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C2 No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (2 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 O No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No E,j-fiA ElNE
25, Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �❑ No LR'N/A El NE
26. Did the facility fail to have an actively certified operator in charge? ElLI Yes No ❑]NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ❑ No 2 NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes E No ❑ NA ❑ NE
❑ Yes L"No ❑ NA ❑ NE
❑ Yes EJ-tvo ❑ NA ❑ NE
❑ Yes ❑-T-�o ❑ NA ❑ NE
❑ Yes B_�o ❑ NA ❑ NE
❑ Yes �No❑ NA ❑ NE
Additional Comments and/or Drawings: ad s y
I2128104

IType of Visit jo Compliance Inspection O Operation Review O Lagoon Evaluation !
Reason for Visit 0 Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
23 Permitted © Certified p Conditionally Certified Q Registered
Farm Name:
Owner Name:
?I-U ing Address:
Not
Date Last Operated or Above Threshold: ..
County: ---------- ---
Phone No:
Facility Contact: _. Title:. ... Phone No: --__
Onsite Representative:'.&Oe� A'Z - Integrator.. -�w �- - „---- ,.,,_- -----
Certified Operator:. Operator Certification Number:
Location of Farm:
AP Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude '
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J0 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 Waxers of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ."0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): h
12112103 Continued

)facility Number: T — g Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (id trees, severe erosion, ❑ Yes Pr
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
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 /)dNo
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 miprovement? ❑ Yes ONo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;Z No
❑ Excessive Poonnnding� ❑ PAN ❑ �yd%multi Overload ❑ Frozen/Ground ❑ C and/or ' c
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan'fCAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? [IYes 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 PrNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 9fNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ yes [rNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;9 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O(No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ YesXNo
Air Quality representative immediately.
%�JiQA2n�l�� ,�7PQvv�mF�� /�f�F..v�D /�2vuar�
41-1
iP
Ono," t5 F_ -5 121n W'09P
Reviewedlnspector Name
Reviewer/hupector Signature:
❑ Field Cove ❑ Final Notes POO
Ar 0
Date: / //'L
12/12/03 Continued

acility Number: --$ Date of Inspection I Z 13 O
Required Records & Documents
21 _ Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes j( No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Qj No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
JVNo
/VNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
28. Does facility require a follow-up visit by same agency?
❑ Yes
o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
AI
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
XYes
fflWo
31_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ONo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[a No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
Po
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
PNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
OT.No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute inspections ❑ Annual Certification Form
7 No violations or deficiencies were noted daring this visit You will receive no further correspondence about this visit.
00-Vr a boozz z gwpoo, -T-� pL"-r,
&u OceT NC..( -AM
I2112103

Type of Visit Q Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Other ❑ Denied Access
Facility Number 2 D Date of Visit: Time:rO
Not Operational 0 Below Threshold
O Permitted E3 Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: _ — 3 County: jorn
dev—
Owner Name: Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator: Aew/t/
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 " Longitude 0 4
Design
Swine Ca achy
Cu�'r"e`nt Design Current Design Current
Ra Motion l;oultry Ga acitV P,o ulat'on Cattle Ca aci P,o ulatioa
❑ Layer ❑ Da
❑ Non -Layer iry
Other
Total Dt ign C►apacity
Total SSLW
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons I�
Holding Ponds 1 Solid Traps
❑ Subsurface Drains Present ❑ La oon Area
❑ Spray Field Area
❑ No Li uid Waste Mana ement S stemJ��i
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ® Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Was tg ollecti n 8r Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 7iZ p
05103101
,0 Yes ❑ No
❑ Yes ❑ No
DKYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: — VE Date of Inspection
5. Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do anv 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 anv 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 maintenanceiimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? Excessive Ponding ❑ PAN U Hydraulic Overload
RYes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVE MP)?
❑ 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
Reauired Records & Documents
17. rail 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/ WGP, 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. rail to notify regional DNVQ of emergency situations as required by General' Permit?
(ie% discharge, freeboard problems. over application)
❑ Yes
❑ No
23. Did Reviewergnspector fail to discuss review•linspection 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
t0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about tisis visit.
Ctimettis,(refer fA gceson �€j: `Ezplam.auy YES answeis andior;atty �eommendatro� or am�,other comet �'
; . _ v _ in
Use drawings of facility, to better erplatn situations. (use additional pages as necessary Field
Fteld CoAV ❑ Final Notesb -.
:: ,__.;• : P : �....�.�
4 epmI k6i4 ;P�­ ✓t c ti r !w"
rAk
1
.7�or��,:e� AtIv Mite Ir ol—,a
Reviewer/lnsgectorName ,: ` .-_`"�' „�;, _�-d^'�
�_,.
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: —
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
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 permanenthemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments "d/ok Drawings::, x °; ""
pp
r
erG
/4ecor� ;
14
lu.n!!tv( .�/%A� /Z�2���3 �— ��rr�- o� a•� 1/1 f4�.
DM
1�i /$ eO 1-61`h7st 7is/�
/n Yiil.'
05103101

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit/ 91Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑Denied Access
Facility Number Date of Visit: Time:
Not Operational 0 Below Threshold
Permitted O Certified 13C��onnditionally Certified D Registered Date Last Operated or ove Threshold:
Farm Name: K County:
Owner Name: — �_- _ Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:��a� LNG
Certified Operator:
Location of Farm:
Phone No: `
Integrator: L/'eO 1
Operator Certification Number:
W Swine []Poultry ❑ Cattle ❑ Horse Latitude 0' 0° K Longitude 0' 04 =u
Wean to Feeder
Feeder to Finish
Non-
N
■ -- ;�■ � I� :�� �' _, � are � -
--
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ["No
Discharge originated at: ElLagoon El Spray Field ElOther /
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 gat/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 o
Waste Collection & Treatment /
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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? , ❑ FAccessive Ponding ❑ PAN ❑ Hydgulic Overload
12. Crop type
13. Do the receiving crops differ with those designa d in the Certi
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?
Reauired 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 r), No
❑ Yes �No
❑ Yes (�No
El Yes VNo
❑ Yes jZfNo
❑ Yes 1�No
ElYes VNo
i
U Yes U No
❑ Yes [-]No
❑ Yes [,� o
❑ Yes / No
❑ Yes �4o
❑ Yes No
❑ Yes No
❑ Yes No
El yes �No
❑ Yes ��fNo
❑ Yes ,l�,(N0
❑ Yes /yJ No
El Yes XNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commenfs.(refer to&questuin #} �Explam any YES:answers'a�d/or any r caiitmendati or,ariy der comments � ?
--r -=—
Us'e'drawingVoFfacility to better ezplatn sttuattons {(use addtttonal pages as necessary) Field Copy ❑Final Notes
r
A%�� : F��,�y iz�, F�s� �,� C.eoFe
Reviewer/Inspector Name :
Reviewer/Inspector Signature: Date: 7� ?�
05103101 Continued

Facility Number: ?- Date of Inspection EOP
or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ Yes 10 No
❑ Yes �No
❑ Yesyr
o
El Yes ❑ No
Additional Comments and/or Drawings:
A6
05103101

Division of Water Quality
Q Division of Soil Water Conservation '
'- Q OtherAgency:
{Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit X Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tigne: i 1__?.�� Printed on. 7/21/2000
Q Not Operational Q Below Threshold
Permitted [3 Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: .......................
Farm Name vv ...................
K ........: S County: ....................................................
......................................................
OwnerName......................................................................... ................................................... Phone No:.......................................................................................
Facility Contact: .............................................................................. Title:
MailingAddress: ..................................................................................
Onsite Representative: �'`'�-��
.............._.J.............................................................
Certified Operator: ................................................... ..........................
Location of Farm:
Phone No:
Integrator:.....'.. �t.....�` �. .........
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 ram« Longitude 4 «
Design Current Design Current Design Current'
_.
Ca ci Population Poultry CapacityCapadty Population Cattle Ca CI ._ _ N ulation
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish p ❑ Non -Layer ❑ Non-Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total DesignCapacity
Gilts � .ty -
Boars ToW :SSLW
Subsurface Drains Present La Area Spray Field Area
- --Ndmber.of Lagoons � s;^r►a ❑ P Y
y Holding Ponds 1 Sofid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 4 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 E15No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................... .......................................................................................................................................................................
Freeboard (inches): 3F
5100 Continued on back

Facility Number: — Date of Inspection C�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �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 PNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ff No
12. Crop type `p�,s SQ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�•�io•yiglalrigtis;ei' d�fic�enc�e� •rv�re jrtQfe� d�tri�ig th�s;v�s�t; • Yoh will->�ee�iye too �uirth$r • : •
correspondence atbotiti this visit: _ .. _. „'
❑ Yes gNo .
❑ Yes qNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes allo
❑ Yes KNo
❑ Yes &No
❑ Yes ONo
❑ Yes qNo
❑ Yes Mo
❑ Yes ONO
❑ Yes RNo
❑ Yes WNo
❑ Yes. J;aTfo
�0'r _. tl
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: a- - 'V^ Ol S/pp

• Facility Number- 1 — '( €);etc of Inspection � Printed on. 7/21/2000
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation? 0
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �L No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Kio
roads, building structure, and/or public property)
(�
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
�1
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
ONO
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
gYNo
Additional Comments 'and/orDrawings:
5100

/Z6t4'• "5 = 5 Revised Aprfi 20, 1909
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
=atiltty Number r7 V Operation is flagged for a wettable
�
Farm Name: r F� { +"'� s 3 acre determination due to failu a of
On -Site Represents 've: goo(A4 Part 11 eligibilityitem(s) F1 F3 F4
inspector/Reviewer's Name: Operation Operation not required to secure WA
determination at this time based on
Date of site visit:_ ) Z l 1110 U exemption E1 E2 E3 E4
Date of most recent WUP: i Zl3d �7 Operation pended for wettable acre
- _ .-determination based on P1 P2 :P3
Annual farm PAN deficit pounds
lrrigation Systems) - circl r: 1 hard -hose tmvele ; 2. cent=., -pivot system; 3. Iinear-move sysf=m;
4. stationary sprinkler system w permanent pipe; 6. stationary sprinkler system w1port2ble pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART I. WA Determination Exemptions (Eligibiiity failure, Part 11, overrides PGA I Exemption.)
El Adequate irriaation design, inciudin_a map depicting wettable acres, is complee
and signed by an I or PE.
E2 Adequate D, and D21)3 irrigation operatino parameter s-heets, includino map
depicting wettable acres, is complete and signed by an I or PE.
E3 -Adequate D, irrigation operating parameter sheet, Including trap depicting -
wettable acres, is complete and signed by a WUP.
E" 75% rule exemption as verified in Par Ill. (NO T E:75 % exemption cannot be
applied to farms that fail the eligiblity checklist in Part 11. Complete eigibuiiy
checklist, Part II - F1 F2 F3, before completing computational table in Part II1).
FART 11. 75% Rule -Eligibility Checklist and .Documentation of WA Determination
Requirements. WA Determination.requiredbecause.operation fails nn_ a ofthe-eligibuity -
requirements listed below:
'F1 L:k.ofmcreage-3Mlchresuliedinmve mpniication:bf-�vas•te:v=-t=r(rAN) on3przy-
fie!d(s)�c�rdina�ofarm'sdastiwo�reas�ftiricatinn�ecoss:.
k F2 Unclear,rillegible,-or lack of informationimap.
_ F3 Obviousjie!d•iimitaaonslnumergus:diiches�:fgifute o:rieductrquired:-�_
bufferlseiback-zcreace;mr2b%mftotalm� ae�denimeddn-LAWMP3ncludes� -
srnall,-irregulariy-shaped fields=.-fields-iessfhan-5mc_resfor.t7=vekers7orJessfhan -
2 acres formtatianary-sprinklers). =
FY WA determination required because CAWMP credits leld(s)'s eweage in excess _.
of 75% of the respective field's total acreace 2S n in e.,1

Facility Number r7l -B
Revised Apn120, 1999
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT TYPE OF. l
NUMBER 'a �Rs��
Rrs
TOTAL
ACRES
CAWMP
A
FIELD IcOMn[Ms'
Yy
Ry
Q
FIELD NUMBER' - hydrant'., pull, zone, orpoint numbers may be used in piece oTne!d numbers depending on CAWMP
and type of irrigation -system, If pulls, etc. cross -rnore than one field, insnectorrrevie:ver will have to combine fields to
calculate 75% field by fre!d determination for exemption; otherwise operation will be subjee, toWA determination.. - - ----
FIELD NUMBER2 - must be cierriy de!ineated'drim2p. - -- -
COMMENTS' - back-up fie!ds with CAWMP acreage exceeding S% of its toil-ac as and havingrece!ved less than 50%
of its annual PAN as-doccunenied in the fanWs A.e Custwo years'(1997 & 1Q23) of inicavon-recores,-cannot serve -as -the
sole basis -for requiring a WA Dejwrmiation::Eark-un:fle!ds- muete-noted intre-=mmpnt3_-_mcnmid must be accessible
by irrigation System.
Part 1V. Pending WA Determinations -
Pi Plan lacks. followinginformabon:
P2 Plan revision Tnay:satisfyZ5% rule based on adequate overall PAN deficit and by
adjusting all field mcreageJo below 75% use rate
P3 _ . - Other (fern process of installing new irrigation system):

jaDivisron of Water Quality ' e
O_Division of Soil and Water Conservi it
O OtherTAgency
Type of Visit $Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .0 Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 1 g Date of Visit: 1 lar Qt7 Time: �Printed on: 10/26/2000
Q Not Operational Q Below Threshold
© PermittedZCertified © Conditionally Certified 17 Registered Date Last Operated or Above Threshold: .............
Farm Name: .........�..°� ..........................................................
County:..�r!'.r..................................... .............
....... ...................
OwnerName:...... r ti • .5................. I........................................................................ Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:..........................
MailingAddress: .......................................... .............................
of
Onsite Representative:...`'...1.-....'.`.....................................................
Certified Operator: ................................................... .........
Location of Farm:
Phone No:
Integrator: ..... M rl rer•t.l... ...............
Operator Certification Number. .........................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 14 Longitude ' 4 «
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
Feeder to Finish
11,50
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present J10 Lagoon Area JOSprayField Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Disc�es & Stream Impacts.
1. Is any discharge observed from any part of the operation? ❑ Yes YNo
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) ❑yesNo
c. If discharge is observed, what is the estimated flow in gal/min? h t1
d. Doc,; discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 7g 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier1 ............ .................................... ........ .......................... ......... .......................... .................... ......... ..................... ..............
Freeboard (inches): ,31
5100 Continued on back

Facility Number: rl I— Date of Inspection Printed on:
. 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 of
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?
10/26/2000
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 �e r ram+ vG�'� Jla•4 ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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?
.. Rio vi.. tioiis'ot- deficiencies -**ere h6ted- dtWirig #his'visit.' • Y:ou :rviil 7c 1. a sio further
;correspondence. about this visit.. .. .
❑ Yes 13fNo
❑ Yes No
❑ Yes f No
❑ Yes No
❑ Yes KNo
❑ Yes XNo
❑ Yes ZfNo
❑ Yes �OrNo
❑ Yes ❑ No
XYes ❑ No
❑ Yes ❑ No
X Yes ❑ No
[:]Yes &No
❑ Yes KNo
XYes ❑ No
❑ Yes No
❑ Yes No
❑ Yes OrNo
❑ Yes V No
❑ Yes No
❑ Yes No
❑ Yes f No
Comments (refer to question #): Explain any YES answers and/or_any recommendations or -any other cornmeuts_`
Use drawiings',of facility to better explain situations. (use additional pages as necessary):=
r4 . Fe_ 1,--} y vteedekc,-e s O�e�er►'����t��o� , �
�ve5�a-�o�-. �armt5. week 4bMe
lwl���e br✓r^�,t<do, it �^-�,°rs;.L� ;., �,�.�� brvgr� zoos . igrPl� l�+�.e
A4 I 4'O."! a.tee,
tcL�oah otes:yhlvv/v,le c4eek "it-toolmce)'ev-t.
j q . Use be ..� n, y �fdN �IT� i,� ice �� �►..-. w^-c-le, p la z, e►i Z' f Use
ahar�r►f � Gd tvHli;, 4,xjj ote A,Q�i:��id� o,, �.
Reviewer/Inspector Name
Reviewer/Inspector Signature: d Date: 1 rr oa 5100

Facility Number: 02f —S&I Date of Inspection %�* Printed on: 10/26/2000
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below J9Yes ❑ 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 n No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes >f'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 ;S No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JO No
31. Do the animals feed storage bins fail to have appropriate cover? []Yes -0No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? IWYes ❑ No
5/00

© Division of Soil and=Water Conservation - Operadon Review
[j Division of Soil anti Water Conservahon'- Compliance I>Espect.on
x Division of Water,(jtiahty Complia�ce•Inspectiun
C[Other Agency Operation'=Review, a _
Routine O Complaint Q Follow-up of DW2 inspection Q Follow -tip of DSWC review Q Other
Facility Number ( Date of Inspection
Time of Inspection f 30iJ 24 hr. (hh:mm)
© Permitted Certified 0 Conditionally Certified © Registered Not O erational Date Last Operated: ..........................
Farm Name: h 1 ...--rC°!►"'�5.......K-7 ... County:...... !''G`. .........................tv.; .4.0......
Owner Name:.. .......................... ........ - Phone No:
Facility Contact: ................................................ .......................... Title:......:.......... .. Phone No:........---.----.......
............................................. ....................
Mailing Address:
Onsite Representative:........ V t��. Integrator: k1dejap•.
............................................................ - ........... .................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
..................................................................................................................................................................................................................................................................
Latitude ���` Longitude
Design Current Design. Current Design Current
Swine Ca acity Population Poultry` Ca aciEy Population �,' Cattle Capacity Popula Ca on '
❑ Wean to Feeder ❑Layer JE1 Dairy
Feeder to Finish ILO Non -Layer 10Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts,
❑Boars _ W ,:Total-SSLW
- Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
HoldtngPon&'/ Solid Traps �` ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: D
Freeboard (inches): ...........
............................................................................................................................. I.... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes qNo
❑ Yes )QNo
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ONO
❑ Yes
P-No
❑ Yes
r No
Structure
6 -
...............................
❑ Yes No
Continued 0n buck

Facility Number: - Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require 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
112-.1-177
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�; �'Vo vioiafitjns:oT deficiencies -were noted dix`ing tl�is;visit: Yoi� wiil receive Rio fu�thgr ;
..-CO ri es ondence. aN f th' :visit:
❑ Yes gNo
❑ Yes XNo
❑ Yes W10
❑ Yes �No
❑ Yes ,<No
❑ Yes WNO
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNNo
❑ Yes �N0
❑Yes. P(No
❑ Yes o
❑ Yes &o
❑ Yes Po
❑ Yes 1 No
❑ Yes �flxo
❑ Yes '�No
❑ Yes ENo
El Yes /�N0
Cagtments:(refer taquestion #) Explatri',auy YES answers 6rid/or any_recommeudations or any other Cori ments .`
Use_drawin' of facilE to`better explain situattoiis {use ad' p g as -necessary Y T
m w,
gs ty tional `ages as -necessary =�
Reviewer/Inspector Name
Reviewer/Inspector Signature. _ Date:
3/23/99

Facility Number: [ - fCJ 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 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 J.hlo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
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
M 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 to
o
31 _ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additionall omments and/or-Urawin
❑ Yes No
3/23/99

Revised April ?Q, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 1/- 7?
Farm Name: Aia
On -Site Represen alive:
lnspectorlReviewees Name:R �
Date of site visit:
Date of most recent WUP: o�
Annual farm PAN deficit: pounds
Operation is flagged for a wettable
acre determination due to failure of
Part H eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation Systerri(s) - circle . and hoseiraveier, ..center --pivot system; 3. linear -move system;
4, stationary sprinkler system wlperm , .stationary sprinkler system wJportabie pipe;
6. stationary gun system wJpermanent pipe; 7. stationary gun system wlportable pipe
PART i_ r}A Determination Exemptions (Eiiaibiftyfailure, Part 11, overrides Part 1 exemption.)
Et 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 Ill. (NOTE:776 % exemption cannot be
applied to farms that tail the eligibility checklist in Part IL Complete eligibility
checklist, .Part 11 - F1 F2 F3, before completing computational table in Part lit).
PART 11.75% Rule Eligibility -Check list .and -Documentation -of WA Determination
Requirements... WA-Determination'.required because operation fails one of the .eligibility
requirements listed:below: .
_F1 Lack.or--acr—=aoeavnicnTesuiiedin:over:application-mf-wast--water(P.AN) on:sprey_
field (s)-mccordingfo-farmSdasttwoa►eas aaf.irrigadonzecozds.
F2 Undear;-illegible, or lack &informaiionf=:n _
_F3 ObVIous7leidiimitationslnumerous:ditches�ailurs:-to=deductsequirecl�.-....
bufrArlsetback:acreage;m- r26%tof:totaLacreage7deiriineddn-CA11 MPilnciudes =�:
smal[,Tin-eaularly:shapeftelds --fields=less-ffian:5tcres1or_.travelersmdessrthan`-.
2 acres -for-stationaryzprinklers).
F4 WA determination -required 'because CAWNIP. creditsTleld(s)'s acreage in -excess:-
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, I999
,F
Facility Number -
Part [it. View oy t-ieia ueterminanon
or [:)7o txempuon
Mule Tor vvH uetermmation
TRACT
NUMBER
FIELD
NUMSEW-2
TYPE.OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
°!o
COMMENTS3
i
i
i
i
i
FIELD NUMBER- hvd.-ant_-null.zone:-or.-Dointnumbers -rnav be used in glace -of field numbem benendino on CAWMP
and type of irrication-system: If pulls, -etc: cross -inore-than -one field; inspectorireviewer will have to combine -fields to
calculate 75% field by Field determination for -exemption; -otherwise operation will be subject_ to WA determination.
FIELD NUMBEs -must be rleariy belineated ion -map.
COMMENTS' --backup fields -with CAWMP aLF-sage-Eexceeding.75% of iisfotE�acres-and-havingTeceiveddess than 50%
of its -annual PAN 2s:documentsd-in the-hann's-mrevious±wa_years'(19974.1998)nTirrigation-T--cards,.cannot-serve7asJth-s
sole-b2sisTforrequiringa WADaietmination:::Backup3ieldsznustbA�toiAd'intnezomment:secbommnd-m[jstbe-accessible
by irrigation system.
Part IV. Pending WA'De#erminations
P1
Plan Jacks following information:
P2 Plan Tevision-may saiisiy-75%-rile-based .onadequatn.overall.PAN dencitand by
adjusting mll neld:acreageia below 75% use --rate
P3 Other (iern process of installing new irrigation system):

[] Division of Soil and Water Conservation ❑ Other Agency
Mivision of Water Quality
ne
Facility Number
of
[] Registered Certified © Applied for Permit C1 Permitted
FarmName:....................K.�......................._.................................
Owner Name: ............ Kn"..... .f.. ...........................
How= of DSWC review O Other
Date of Inspection 1• j� -`�
Time of Inspection Cj' 3d 24 hr. (hh:mm)
0 Not Operational Date Last Operated:
Po
........ County:.........I.......................•--...
L.`.,!............................
......... Phone No:.......„ (6.- - Z 5 Z(� `j 2-
.........................I.......................
Facility Contact: ............................................................................. Title:....................... . Phone No:
.............................................................................................
AY
Mailing Address: .................... Z.A ...... &.-e.I```.........' �",7....IG`7........... ....1. 6- �!.4.ryrCll. .....2 g.R. ..... ..........................
Onsite Representative:......_....:" r am.. ..... Integrator: ................
^..I......................................................................
Certified Operator :-------------------�.�` .-`-'.�--...- ....t...................................................... Operator Certification Number ;.........................................
Location of Farm:
0
Latitude ' 6 " Longitude • 4 "
E
Number' of. Lagoons /Holding Ponds i ❑ Subsurface Drains Present❑Lagoon Area ❑Spray Feld Area
F a ❑ No Liquid Waste Management System
r. {
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes o
2. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes V No
b. If discharge is observed, did it reach Surface Water? (If yes, notify D1N'Q) ❑ Yes ! a
c. If discharge is observed, what is the estimated flow in gal/min? f V
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes *No
3. Is there evidence of past discharge from any part of the operation? El Yes VNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes XVO
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes �Vo
maintenancelimprovement? //
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes *No
7. Did the facility fail to have a certified operator in responsible charge? El Yes No
7/25/97

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures aAgoons,Holding Ponds,FlushPits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):.,,.. .............................
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of ,questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes
�No
❑ Yes
)(No
Structure 5 Structure 6
................................... ..................... I.......
❑ Yes
tr<o
Yes
❑ No
VYes
❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste_Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type..........................................................................................................................................
................... ��----,
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0, No.vitilatiohs-or deficiencies: were noted iiuring this"visit.- Yov.vKill `receive iro•ftirther : -
;•correspQnde�cealiou�tttis:visit:•:•:�.�:::..•:•.•:�.���:-�. .:: .:.:�. .:.::•�:::•.: .•
F c V Qr05;e"l CCAj i`1 l4�aDa� �. ��4CI-ty G,a re- see C/.,
l $ � 44 If S ee-4 r y e- tr D 0 � �-ref 1 � c"41
y
f/cc
w�54_c a�.arys7 .,fix mCJ.JJ
❑ Yes �No
❑ Yes �No
❑ Yes bKo
❑ Yes ( No
Kyes No
❑ Yes (NO
❑ Yes 'RfNo
ElYes (W-No
Yes ❑ No
❑ Yes KNO
❑ Yes N o
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: L11"_ y/ Date: ] J — / � —