310299_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

i ype or visa: v v ompnance inspection l.J uperanon mevrew l.! structure nvamanon V i eCnnlcal Assts[ance
Reason for Visit: 40 Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
��r.ri�i ir�nr_
Date of Visit: Arrival Time: p Departure Time: / County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
I--
Onsite Representative: Integrator:
Certified Operator:
Phone:
Certification Number: /,5/ 1--cr—
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity an.
W n to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Nan -La er
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
can to Feeder
�9 D
Op
Feeder to Finish
Design Current
D , P,ouIt , Ca aci P.o
Layers
Non -Layers
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non-Dai
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other j
Turkeys
Turkey Poults
Other
DischarPes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E]' V�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
DNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EJ—Nio: NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
g No
[] NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

rFaility Number: - L Date of Inspection: 1/77
Waste Collection & Tr eatmient
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [,To ❑ 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: 2? qt_ 2_Z `{ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 0
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 P "O ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [%�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,���
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LQ 1 o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P�<_ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E5*No
[DNA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ZTNo ❑ NA ❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes EDITo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes _Efr90
❑ 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

jFqxility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑v ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3'5o_`❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No hl ❑ NE
s
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �lo ❑ 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
I o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
No
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[;�
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J
1 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Eg No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L.a No
❑ NA
❑ NE
Comments (refer to question #):;Explain any. YES answers and/or any additional. recommendations or, any o.ther,comments ±
Use drawings:of facility: to better.,: explain situations (use additional a es as necessary).
Reviewer/Inspector Name: o"Y PD..�, (� Phone: T% 4- v�?0P
Reviewer/Inspector Signature: �k�...1°/t Date: Y 7
Page 3 of 3 21412015

1►11
(Type of Visit: UCC iance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: L1.Y.L�. J County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
W an to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dr, P,oultrF Ca acit Y,o ,
La ers
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
I
Curke s
I Turkey Pou Its
Other
Discharizes and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Eq-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[:]NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [2-Qo ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
Page 1 of 3
L
21412015 Continued

Facili Number: - 2 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: ax 2— Lf-t 3/L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2. 4. 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑Yes No ❑ NA ❑ NE
waste management or closure plan? /�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit`? ❑ Yes �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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2yNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yesdt�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes l No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [y ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E rNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑NA ❑NE
❑ NA ❑ NE
❑ 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 E24o eN
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ONo
❑ Yes , No
❑ Yes eNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
,dNNo ❑ NA ❑ NE
[�No ❑ NA ❑ NE
��N ❑NA ❑NE
Reviewer/Inspector Signature: Date: O
Page 3 of 3 21412015

2
(Type of Visit: 0 Co pliance Inspection U OperationReviiew.'Q Structure Evaluation '■Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j Q 01 S
c� s
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design Current
Design Current
Capacity
Pop.
VVet Poultry C««specify Pop.
Cattle Capacity Po
TFecder
La er
Dai Cow
7Farrolwto
Non -La er
Dai Calf
Dai Heifer
Design Current
D Cow
Dr. P,oultr. Ca aci P,o
Non -Dairy
Farrow to Finish
I
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Beef Brood Cow
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes V31�o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes l ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 21417011 Continued

Facili Number: - 2,Date of Ins ection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej__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: �� L}
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 [% No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envi nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 0Q Yes En"NNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FNo ❑ 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 E5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes El"No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? E7fYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EI No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
u , to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[TN'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes ❑ N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ENo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No Fj_NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
D Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3No
❑ 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
Ej No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
I ZI No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[21�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
5--No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/oraany additional recommepdations or any othef comments.`
Use drawings of facility to better explain. situations (use additional pages as necessary): ;
2J ()e S�v
t CL--d 1 n ; P'i f 12 Nt rL,
Ct�_ ret, T Akz ra-s)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
f� fa'_e(
Phone: y
02 [ 6 7.30Date: Z
21412014

Type of Visit: Veompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: fd'Routine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: ' Departure Time: County: zholpf
Region:�
Farm Name: Owner /P�/Yi Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:a
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude.•
Phone:
Phone:
Integrator: / rL
Certification Number: 0 f7
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
I
Design Current
Wet Poultry Capacity Fop.
I Layer IDairy
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder 11
INon-Layer EA
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Desi
D Cow
Farrow to Feeder
Farrow to Finish
110), P,ouitr,FC..WP_8C=ityP'0P.
Layers
Non -Dairy
Beef Stacker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other i
Turke s
Turkey Points, -
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes '[allo
❑ NA ❑ NE
❑ Yes EfNo
❑ NA ❑ NE
❑ Yes '[TNo
❑ NA ❑ NE
❑ Yes,,Eno ❑ NA ❑ NE
❑ Yes WNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
2/4,2011 Continued
II

Facili Number: IDate 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 �ZNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 0
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 property addressed and/or managed through a
❑ Yes 121"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 5?No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ZNo
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes_,L21�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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 &ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 0No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ;R o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 5.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
'RNo
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes gNo
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �3/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _12^No
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued
r

Facility Number: - Date of ins ection: IF
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesoNo ❑ NA' ❑ NE
25. Is the facility, out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 'J2'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C;�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ;2'f,;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 ,rNo ❑ 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 .oNo ❑ 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 j—, o ❑ NA ❑ NE
�"
❑ Application Field ❑ Lagoon/Storage Pond ;;, ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Z"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes AE:r No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes ZNo ❑ NA ❑ NE
Comments (refer to question ft 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).r11d/3
k
acK Cf ZL �e
fif (6-1-� frAM
cam.
'72
0 t -1`/ 2.
\"I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ! 7 y. j�
Date: �
Ilfllv
412 W1

Type of Visit: mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County: Region:'
Farm Name: �1§Zr1_62Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: :ZW,!;r
a
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: d
.Certification Number:
Longitude:
Design Irlrent
DesntSwine
Capacityop.
Wj
Wet Poultry
Capacity
Pop.
Cattle
C►apacity Pup.
RWean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
P"o_u[tr
Ca aci
P,o
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
7Dr.
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes �o
❑ Yes ,� No
❑ Yes No
❑ Yes�o
❑ Yes�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Ds ection:
O
Waste Collection & Treatment
4. Isistorage 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 J�Z No
❑ NA
❑ NE
Struc re 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 F'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
.0
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 d No
D 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)
_Z
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;�fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �?No ❑ NA ❑ NE
l6. 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ,ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J:;�No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 'fiio
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZrNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EI-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection
24. Did the facility fail to calibrate waste application equipment as required by the perm ?
❑ Yes
ff No
❑ NA ❑ NE
23. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
EEKNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
,.00
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ,
❑ Yes
WNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
JZ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�' o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
T
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/orany additional recommendations or any other comments.
Use drawings of facility to better exalain situations (use additional pages as necessary).
'�4I16r���s � In o2Olj.
�. 7Y
Reviewer/Inspector Name: Kt Phone: V_
Reviewer/Inspector Signature:
Page 3 of 3
Date:
1

(Type of Visit mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QA'routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival ime: �eparture Time: � County: URegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
f
Onsite Representative: c 14 3"'f
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certi ification. Number: =✓2C q �
Back-up Certification Number:
Location of Farm: Latitude: = o = I = 6f Longitude: = o = 6 = «
7.
DcsignCurreesignCurrent
p
wme;'°� Ca aci l'o ulation Wet Poultry r Ca aci 1Po ulation . CattleSP ty P� �- t; ' P. tY, P pacity Population
i.-. 'l �t a.p.r.. ra.,-. ir.Y�is ...ai-s�± �� �t i -:il, .F „+.t.a�. ..srr,... a.Y•r��..: ce '0 .dF i.ti�- tka
-1 amra..
"I ❑ Wean to Finish 7 ❑ Layer 1 ' ❑ Dairy Cow
❑ Wean to Feeder ❑ Non La er ❑Dai Calf
❑ Feeder to Finish fr:, r. airyHeifer
ElFarrow to Wean' Dar Poalt'y ¢' .fin ❑ D Cow
El Farrow to Feeder`�� q k'¢`''�❑ Non -Dairy
❑ Farrow to Finish' El Layers , ❑ Beef Stocker
❑ Non -Layer
❑ Gilts s. ❑ Beef Feeder
El Boars
Pullets ❑ Beef Brood Cow
❑ Turkeys z
Other:ra� V r:_;`i ❑ Turkey Poults
J ❑ Other ❑ Other rtNumber 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?
❑ Yes 2'ffo ❑ NA ❑ NE
❑ YesAn-No
❑ NA
❑ NE
❑ Yes Oo
❑ NA
❑ NE
❑ NA
El NE
[--]Yes
��I�I'o
❑ Yes-f No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jZfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Z No ❑ NA ❑ NE
Struc re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 GL
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yesj2eNo ❑ 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 'L2�`No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) .
9. Does any part of the waste management system other than the waste structures require ❑ Yes_.�No ❑ NA] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Ycs VI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [] Lease Agreements
❑ Ye's'.ffNo
❑ Yes �TNo
❑ Yes �o
❑ Yes �' o
❑ Yes C}'IQo
❑ Yes No
❑ Yes J24o
❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J:144o ❑ NA D NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E -'V ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes ED-<o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes /E5No ❑ NA ❑ NE
25. Ins the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ffNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Vi No ❑ NA ❑ NE
Other Issues �`'
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�No
❑ Yes Zj"No
❑ Yes PINO
❑ Yes ;No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes I /1 No ❑ NA ❑ NE
❑ Yes i" 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). ;r "
LJ _Affd�
l�� sou
o 1-6 166AI
T 0 re
10, u -h f,45�, G✓,v /e 0 4&IyASr-
Reviewer/Inspector Name: �e�V ,
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2 11

tpe of Visit �Grompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for VisitAOoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ime: % Qt] Departure Time: County: Region:
Farm Name: h`/ls r r�!/�ri Owner Email:
Owner Name:
Mailing Address:
Physical Address:
" Facility Contact: Title:
Onsite Representative: }X?ry h S
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:/5
Operator Certification Number: ;4gQv, QP^
Back-up Certification Number: f `TeR 1
Latitude: == d 0 N Longitude: = 0 0 6 0 1{
Design Current
Swine **apacity Population
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
[] Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ D Cow
❑ Non
❑ Layers
❑ Non -Layers
El Pullets
❑ Turke s
❑Turke Pouets
❑Other
-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes';ETNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes .AErNo
❑ Yes )eNo
❑ NA ❑ NE
❑ Yes /o
❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ,�
Qr�o ❑ NA ❑ NE
[:]No ❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 4 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 ,ffNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes „ TNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ;a -No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes J;a"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes JZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ff No
❑ NA
❑ NE
Reuuired Records & Documents
t9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C30No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
R No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
;2rNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
OfNo
DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection
Fkenuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. X Yes .0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard A Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ 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
VN o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
ONo
❑ 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
j2l�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?
El Yes
L/f No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,ICJ No
❑ NA
❑ NE
Add�tonahComnents'aniilor Dravvin sf
s T �:��
�'" 1�`;`•
ece
f6A/li�r
7/y
Page 3 of 3
I l/lB/BQ

b '7
e 1VlSlOn of WSIteCoQualliy
FaCtilty'NUltlb'Cr �;Divis�on of Soilland,Water Conservation
s , ther�Agencyttb` t%T(ty
��ffi_�wec�#'�����'a
Type of Visit /) Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit�eRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Time: County:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
OW
Phone No:
Integrator: ZA
Operator Certification Number:
Back-up Certification Number:
Region:Z' - )�
Latitude: = c = ` = " Longitude: = ° 0 4 = i1
Design Current, ,} _ �ID'sign CC
aap Y
C1'o ulatioln h „Wet Pdultr CcitPa
P- P i Y . 1 P.
a
❑
Wean to Finish
Other
,s
❑ Other
3 a
❑ Layer
❑ Non -La er
y Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Calf
Heifer
LJ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
ZINo
❑ Yes
Zr; o
ElNA
ElNE
ElYes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
x
Waste Collection & Treatment �E4
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 24 k1Z 2 L
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 �'Nlo El NA El NE
❑ Yes ;;rNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes WNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;2rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;;'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JdNo ❑ 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 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
PNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
El Yes
// No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
'Comments {refer to question; #) :Explain any YES.`answers at�d/or anyrecoar►mendahonsturyanyr►thercomments
Use drawings,of#acility to'bettei explain situations. (use additional pages as -,nee
ae C
ev
-1Crar►'t 14,r� Ca
:r..� i E �r�'=? '� Phone: G
Reviewer/Inspector Name I' V
Reviewer/Inspector Signature:
Date:
Page 2 of 3 028104 / Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ 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 [I Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 0�4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0"No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ 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 P'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Mo [I NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes XNo ❑ NA El 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 ANo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional 'Comments and/or Drawings: �k, �,, ;'„°�,'; �r�q,
9 Cy,
SheK !el
ON Q
V16e ke r$ a o ✓ \
Vo f A14 ,I ;t
cwed- ('J Sjc, nkq %su
'Y4J J14(4--- eA^v47An
F __ /�cn
Page 3 of 3 12128104

Type of Visit 10-11506pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ElDenied Access
Date of Visit: 7- Arrival Time ���6 eparture Time: County: �� Regiotf
Farm Name: 1� //� Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator: _
Location of Farm:
Title: Phone No. -
Integrator: _ lw'45
Operator Certification Number:
Back-up Certification Number:
Latitude: c =' = Longitude: = o
Design
ent
Curr`o
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
---
Cattle C**specify Population
❑ Wean to Finish
JEI Layer I
I
❑ Daia Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ DEY Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
Lulurkey Poults
10 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?
❑ Yes 2< ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes a No
❑ Yes No
❑ NA
❑ NE
❑ Yes Ll No ❑ NA ❑ NE
12128104 Continued

.:
Facility Number: 13 — Date of Inspection
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
identifier �&
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1r
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ZN'o ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ['v
6. Are there structures on -site which are not properly addressed and/or managed ElYcs,- 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 Z2<
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes -f 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 iJ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ; 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 Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes _2< ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 42<6 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes J2—No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 43"Ro ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes g>o- ❑ NA ❑ NE
Comments (refer to question:#) Explain any YES answers and/or any recomrmendY t ons or anyother comments.
Use drawings of facility to Better explain.situahons: (use: additional page's as gecessaryo):�
�A�yr� ok
p t. t.
Reviewer/ins ector Name � - " ar Phone:
t
Reviewerllnspector Signature: Z Date: 2r
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes�o [I 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 _,0'RIo ❑ 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 6o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 0,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ,B'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 eNo
❑ 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 pNo
❑ 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 fTNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P<o
❑ NA
❑ NE
12128104

Type of Visit !6 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit SdRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Dented Access
Date of Visit: Arrival Time- �� Departure Time: County:
Farm Name: Z I//�Q i/yI Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ' ✓t
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: _ _ or _ _
Location of Farm: Latitude: [:] e = ' = Longitude: = ° =
Swine
Design Current Design Current Design Current
C•annv Population Wet Poultry Cap�aeity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ La era
❑ Beef Stocker
❑Non -La era
❑ Pullets ❑ Beef Feeder
❑ Turkeys ❑ Beef Brood Cow
❑Gilts
❑ Boars
Other
❑ Turkvv Pouets
❑ Other Number of Structures: a
❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C:�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ZNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fflNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Struct e 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;;�No
❑ NA (IN E
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;2'No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J;�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
R. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1110
❑ 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 type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P!rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
EfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�'No
❑ NA
❑ NE
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [YNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑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
9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
VNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
9fYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P!rNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JZ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
:zNo
❑ 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
11� 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
16No
❑ 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
2No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VfNo
❑ NA
❑ NE
AdditinnaC Comments ' ' :` .rN MI
WSJ I'vo JIV e S��v y h` ory
s
fur vet a .s ors- $141,A slue 4me
foolell Y
" 1, jwe
ale. C w;;e {z'
0 Ile 1'a11 s GG a S
r/ r�Pe-�cly
Pi
Page 3 of 3 12128104

A)'Division'of Water Quality
FacilRy Number 3 0 Division of Soil and Water Conservation
0 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
Date of Visit: Arrival Time: . Q Departure Time: County: .
Farm Name: 2V4 L Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �.✓L S-�eID��S
Certified Operator:
Back-up Operator:
Location of Farm:
Sr'vine
Wean to Finish
'Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
4 Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:4ZL/92
Latitude: = e = = Longitude: ❑ e =
Design Current Design Current
Capacity Population. Wet'Poultry Capacity Population
❑ La er
✓ .. - --
IEJ Non -Layer
Dry ;Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puuets
❑ 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
CattleCapacity Population'
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
i
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes E�'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes []No []NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0'No
❑ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 31 — Date of Inspection S
Was Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J2rNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes L'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 j(] 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 QNo ❑ 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/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) eii i ��� E G .r)yo rS—a j 1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;;Jlqo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes %Io ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes O No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ONo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ;;KVo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other <comment s
Use drawings of facility to better explain situations. (use additional pages as necessary):
4
Reviewer/Inspector Name I l Shone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility;Numher: 31 Date of Inspection
,,.
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑ Wi1P El Checklists El Design ❑Maps [3 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 J2rCrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VfNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
L] NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[rI No
Z NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
10 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl 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
I
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
Additional Comments and/or Drawings:
y/6/ob 4 9'
11,1106
lr
r.�
1,3
1.3 � (WeCd1-�o�r�s
a Tr��s'kr C q y�eUs cl ��- a r
- FarM
Page 3 of 3 12128104

Type of Visit �mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visitt CWoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: lU r d Departure Time: County: Region:
Farm Name: 5dQ le 64- r:xu _JL= Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: `` Title:
Onsite Represetttative: rPGC 5 "'�e '1g )3 S
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Numh
Back-up Certification Number:
Latitude: = o ❑ 4 ❑ Longitude: ❑ ° ❑ 1 ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
MAINhan to Feeder i7
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _ f
❑ Layer
❑ Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dair Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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)?
Number of Structures: ©.
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 Mo ❑ NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑�No
❑ Yes
Ll No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection 24
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
Stru�ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d2
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 a 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 2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes .ErNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZMo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2VNo ❑ 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. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 2Rlo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes 21Ao
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �:Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Jallo
❑ NA
❑ NE
Reviewer/Inspector Name!/%?/! O fey l l3 rt ttr
Phone:
Reviewer/Inspector Signature: Date: Q
12128/ 4 Continued

Facility Number: — Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [--]Yes -ETNo []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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. '[�Kes ❑ 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 EINo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No,,L2'NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
,ETNo ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No 5'NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No _0NA
❑ 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
jfr`NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
Er -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
2lqA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility tail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
ZNA
❑ 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
ONA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
;;KA
❑ NE
Additional Comments and/or Drawings:
a l P1 use ( n log
i r% 5fe G+-Lay)
1 n ycc� S �e �6 as
odor
12128104

of Visit 2lCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit CYAoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number late of Visit: �O Time: � 3V
Not O erational 0 Below Threshold
e pitted 13 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: ............................................................... County: ........v'............................... ..... ..................
OwnerName: ........... ....................................... ........................................................................ Phone No:.......................................................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
FacilityContact:.....................T....................................................... Title:................................................................ Phone No:...................................................
OnsiteRepresentative:.... �,...}..ull6).....'5me-F&Cm e...................................... Integrator:......' 14�..................................................
Certified Operator: ................................................... .. . ......................................................... Operator Certification Number:..........................................
Location of Farm:
[]twine ❑ Poultry ❑ Cattle []Horse Latitude • 4 " Longitude ' 4 69
Dischamees & 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 gallmin'?
d. Does discharge bypass a lagoon system? (If yes, notifv 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
IdentiFiier• I Z
....................................................................................................................................................................................................................
Frecboard (inches):
12112103 Continued

Facility Number: 3 — �Q Date of Inspection t 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
YN
6. Are there structures on -site which are not properly'addressed and/or managed through a waste management or
❑ Yes
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
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
79,
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
7No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancetimprovement?
❑ Yes
Vo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
To
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type H
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management flan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
ElYes
Woj,/
16. Is there a lack of ade uate waste a lication a ui ment?
q PP q P
❑Yes
No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑Yes
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 ;�Ox
Air Quality representative immediately.
a, .,€'re[�,i3i•.iE°We" ":§4:? .!.: ti.t�„,i.aa*;� '; K''id3, "9;;iiF § . 1.. ,E?.Pa."s ",�„"' :.:E4.R§`.a=�'14 L_.S:i,�. 6 `,iS F.3ili4',��:2iUl` ,FEd€ .�.zi. ::.4E��'.k �•yk :i.. R 4;; ?:d I�tE€t�"?;Ih� �.,x§n> §a �-1x.i�.�E:i1 :� "i>fl` 'ia :. t i4}�"'a".{§ t3 3 ,h'r
iComments (refer`to questran#)Expla�n�siuy�YF answers and/or' any recomneadat�ons or,'anyathLeimmebtsa ,,41'" ;;� ,
IUse�drarv�ags of facil�ty�ta better�expla�n�s►tuaaons: (use'add,tzonal pages as�aecessaty)• � Meld Copy � Final Notes '�;'��4``�"
�! i,[ ` g F € a " r ' q. y f fi trr ' iS 4 3f1'11 r' �r 1, F 31t 1 f " ti 3 ' j i 1 a E r (
Reviewer/Inspector Name k.' r';e t €4S.? .; L QL ' . ' 9 .,s i `'s . �t §?tr r%:•Las.i�t ( .'Il•?. . �3 au..-is,�v t � ... :��:, U"I'P l"n, E�l..,aait2
ReAewer/Inspector Signature: Date: 7 t
17/11M2

Facility Number: j Date of Inspection
'jReguired
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
/No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WiJP, checklists, design, traps, etc.)
❑ Yes
E3 N
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNcj
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
V7N9127.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ElYes
28.
Does facility require a follow-up visit by same agency?
El
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
M<O
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

' .4'.i � � 9 . h - .y :F � Dlvislon Of VlrnEer i113)ll $ H
-
s It
§: �1 t 1 � ;1, .Q.DlvfsiuQO#'Sofl:and WaEen �'©gSerVatlon �, r� � � { a ` ;t ��= a
•" t. ,<. ,'. •.S. �'�.. �• _ ..i .. s''a agb. ._S a, t Is ..>F1i,'.6 �..-.. 1.-,c.i�xa t•SSA 11.E �.: tlai uat.. : yc, t6;..:t„iP.�t{E§j1r �.�{:�'�S13EE<,.i!.ia4.,}�0�.4�:Y�t?ro..EFa[�<Y,aF9�:.tSidtlBt,�{E�,��'•�}�{q,��iF
Type of Visit 0 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit q Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
IL_.ZL_J— hate 01' Visit: Time:
N t O rati pal Below T re hold
Permitted © Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 56AGE aRln County:
Owner Name:. —� r_ -. S�EP/F_ n�.4 ... Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0• Longitude
�Desig Currentn.oCa ac'1ri, Desgn ' urrent
' nCSPo uhttiarP�meCa actv,Po talahon ,onlatiori
Wean to Feeder ❑ La er ❑ Da' "i
€"`
Feeder to Finish Q Non -Layer ❑ Non-Dai
❑ Farrow to Weanji
w
❑ Farrow to Feeder ❑ Other
i
❑ Farrow to Finish Total Desegn Capacity; E,3'
❑ {Il lts E
❑ Boars I ,Tots; SSLW
_'"
t � i
Number of Lagoons © " ❑ Subsurface Drains Present ❑ LaCoon Area ❑ Spray Field Area
1 i8
"`Holding'Ponds l Salid"Traps J.O ❑ 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 Ilecti n & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier: of Z=
Freeboard (inches): �;� 40
05103101
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 1`-' No
Q Yes ZNo
❑ Yes 9 No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?-(ie/ trees, severe erosion,
❑ Yes
�9 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
ONo
closure plan?
([f 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
[ZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
RrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
Z No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
11. Is there evidence of over applicatio ❑ xcessive Pononding ❑%PAIN ❑ Hydraulic Overload
❑ Yes
O No
12. Crop type U — J ( l_J
13. Do the receiving crops differ with those designated in�he Certified Animal Waste Management Plan (CAW P)?
❑ Yes
0 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Z No
b) Does the facility need a wettable acre determination?
❑ Yes
[:]No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
Z No
16. Is there a lack of adequate waste application equipment?
❑ Yes
P No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Z 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
V No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
7. No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
24. Does facility require a follow-up visit by same agency?
❑ Yes
21 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to:yuesti64) Explain any YES answers nd/or any recommendations -or any other comments. 4;
S 3-
drwtterexply ain situatrons (use addlhot no al pages asat Qk eces9sa@ryFie[Sd.wCoa.n1.v...aa.•......na., Final -aN41..ot.,e«?s.;r'......._..d
`E
y.'4y�.i+.t4.
. ..,. a. e __ .. .. ....... .. , i...w. w
lan
✓fP1�C � //�,Qm �PPfA,Ps � /.�/'.
� � Q �iY�9�,E,
/� �`O.eDS
Reviewer/Inspector Name �r
Reviewer/Inspector Signature:
Date: /Z
05103101 1 Continued

Facility Number: — Date of Inspection
dor 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 property within 24 hours? ❑ Yes No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i,e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑Yes ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P Rio
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:.
05103101

IVISIQII of Water Quality;,—': h,E
Q Division of Soil, and Water Cooservatlon C ��� � '� ra �
-� • - i j i, I[ � ..ids
Q Other Agency
? i- i
E s' a
[� 3
{Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation f
Reason for Visit eRoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 1
Date of Visit:
Permitted--R!"Certified 0 Conditionally Certified 0 Registered
Farm Name: ...........1....,!.1 fs.....Q.!.g..........!......'\............................................
S �
Q 1 Time: �Printed on: 7/21/2000
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .•
County:..�.?u�P.l..►. ....................................... ...............
OwnerName: .....................eg.�........a.....''!. ....................................................... Phone No:.....
Facility Contact: ................................
..Title:................................................................ Phone No:....................... ...............
MailingAddress:................�.......................�....J............................................................................................................................................................... ..........................
Onsite Representative: VG`j.'.. .�d.�4hh....`..c!?. .......................... Integrator:,!�!��1�t'14.......................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 s 4 it Longitude a 0 6(
Design Current Design Current, Design Current
9wlne "
Ca ci Po elation .Poultry Capacity Population Cattle Ca '' cl ;Po' iilatioo:
VC3
o Feeder $2 QO ❑ Layer Dairy
Y ❑
to Finish ❑Non -Layer ❑Non -Dairy
r to Wean
s` to Feeder ❑Other
to FinishTotal DeslgpC Total SSLW°
i }; —❑
Spray Field Area
Nt>mb0r of Lagoons Z ❑ Subsurface Drains Present ❑ Lag -on Area
n , Aoldmg Fends / Sotid Traps : ❑ No Liquid Waste Management System E
Discharees & Stream Im acks
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is ahserved, did it reach Water of the State? (If yes, notify DWQ)
c. ]f discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: ................
................... ............Z.....................
........................
Freeboard (inches): 3$ 26
5100
❑ Spillway
Structure 4 Structure 5
❑ Yes WNo
❑ Yes JKNo
❑ Yes U9 No
'n le.
❑ Yes �Z No
❑ Yes CRNo
❑ Yes 2No
❑ Yes 0 No
Structure 6
Continued on back

Facility Number: 3► —Zq Date of Inspection I �I.s/11 n1 I 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 f9 No
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan? ❑Yes J0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑/PAN ❑ Hydraulic Overload
e, 12. Crop type E!e � �J
U4C1 i aifUVe, �' �I( 1;rA1'%
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/] n spector 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?
YlQla%iQrjS OC' dtI1C1 nCiCS W rC I1QL@d dIWifig i. s;v. sjt; • Y:op :will • eoiye ii6 fufthtr ;
corresporideike' about: this :visit:
❑ Yes &No
❑ Yes JffNo
❑ Yes J4 No
❑ Yes R No
❑ Yes ONo
❑ Yes 50 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes f No
El Yes me
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes JZ No
❑ Yes t] No
❑ Yes gNo
❑ Yes ONo
❑ Yes No
❑ Yes No
Comments (refer to question*): Explain_ any YES'answers and/or any recommendations or any other comments
Use dravvtnfacility." Metter
xr
'gs;of:'explatn:situations {use`a�irltttonal pageseas
A)ee4o hA,-"/esI I rerVN0Ve CC.V� b be, ie,eq . Sw,ati 9rw%n 6� At11,1 q -z001, .
r c; l �- i�d eecceds A,'e well kefl.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3/1 Ffy D 5100

Facility Number: 3 r —'2 Date of Inspection Q t7P
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 or 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 RNo
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 )UNo
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 :0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
itiona �omments and/or rawm
.- , � ,:.:.. �- .-,r: . � ...,� �, .. .{' � E tLr,.:1:ta E.a.h. �. iy�.,nsd� ,�:L.jT `.t�� 't•�
L

,
e€ : r4i3
Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted Certified Conditionally Certified [3 Registered E3 Not Operational Date Last Operated:
Farm Name: ......... .` ..:`r�'cLS................................................... County:........... .... ...y�...........I.... ...............
OwnerName: ................................................... ........................................................................ Phone No:
FacilityContact: .............................................................................. Title:..................................................... Phone No:
Mailing Address:.....................................................................................................................
......
.............................................................................. ..........................
OnsiteRepresentative:. ...........................................................................
Integrator: ....... &k�jr.'U...............................................
CertifiedOperator: .................................................... .............................................................
Operator Certification Number:..........................................
Location of Farm:
... ... ........... .. ...
Latitude ' ='f Longitude ' 6 it
;Design =; ;Curr'ent Design CurreDesign' j -urrent
,..E, 1
Ca 'ace ...Po ulation,Poultry. : Cal'aci �,, o ulahon';� ,Cattle ,i� FCa" `ae� ;Po ulat on
Wean to Feeder
❑ Layer ; ❑Dairy
Feeder to Finish
❑ Non -Layer ��.+'� ❑ Non -Dairy
Farrow to Wean
E
❑ Farrow to Feeder
�i €, F
❑Othertj
`1j 0 Farrow to Finish
i i t 4
' ;"�ETotal�Design`'Ctpacity,.,'
❑ Gilts
� , s t„ $...
�❑Boars
Num er,of.La oohs
g
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
'1%
.. ..
No Liquid Waste Management System
❑ q g y
31 z
' "i `''.;° w+ F
E Kt FF, ,
P.
d'Pra
Holding Ponds /Soli p
i ,,
„'
. i ,i ,':'tl
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed, what is the estimated Flow in gallmin?
d. Does discharge bypass a lagoon system? (II' 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 XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ............
......... ,o!�.................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes JXNo
seepage, etc.)
3/23/99 Continued on back

[Facility Number: ­(4M I Date of Inspection �
}
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
b'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
MNo
Waste AURlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
'gNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
JNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
CRNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
(jNo
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
10 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Document~
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?
Yes
(iel WUP, checklists, design, maps, etc.)
❑
;TNo
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
EYNo
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
Dq No
22, Pail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
E�(No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
tj 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
P�'No
14 yiQta iQn�s'o dtCelenctes #r re Oofpd• at,-r'ing #:hlsy. sit; • you Will >reetriye tno futftf
cories�oridence' about: this :visit:
,._, y, s _ 11 q , � I .k� 7 1 `f 4 n - '�' €n .: 't i ; f � �� 1 - - � < st .y s
Comments (refer to guest<on #) ;Explain any YES�answers andlor any recommendations or.any otter comments r 3S ='
-• k t 1 'c 1" t 1 M f l 1 - i I 1� "' 1 f, t.
Used_ ravings of acil�ty,to better explam.situat�ons (use add�t�oinalPpages as;necessary)
f t
11 .�3 a, , 1�,1 -�� s' �� ;' l--: � h E.� �. r.� n,.�. , i,•� Ar E, l s Et. , d;.:q i141•.tt ts.. {, 1: d I ,1.d , Cs--NAG-
15 � � �� � ��, ,,��� •-� ., A_ ply ,����
S � ice.
Name
Reviewer/Inspector
' t , �'.., :•E. " i, E , , �`
Reviewer/Inspector Signature: (7-A, \--,— tL � Date: T) — �Q

Facility Number:3 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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?
❑ Yes
No
28,
Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
JUNo
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
1 'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
MNo
Additional Comments and/orraw rngs:
.. . -- ....-.. ...
,.� ..
i, 1.
,
M1

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation O Other
Reason for Visit O Routine O Complaint O Fallow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number 31 299
Date of Visit Printed on: 323/2000
O Not Operational O Below Threshold
© Permitted 0 Certified [I Conditionally Certified Q Registered Date Last Operated or Above Threshold : .................
Farm Name: MU&dale.Z'.arnLJA1L ................................................................................... County: D.Uplin ............................................... W..IR l.........
OwnerName:Ran......................................... &Cphas .................................................... Phone No: 9.10:291.16.52 ..........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Malting Address: 1fi7A.1l.aVAlcn$.Rd................................................................................ W. A aw.NC.......................................................... 2,8398.............
Onsite Representative: Jeam5lep pert.9............................................................................ Integrator:MUx;phy.y.ari*.ja= .....................................
f
Certified Operator: ,lean..C'.................................... Stepleaa.......................................... Operator Certification Number:.18I$.............................
Location of Farm:
sae rn�.l.]arutian;..�e.i]S..X27..N.to..l�'arsa�;.at.atap:.light,.zu�a R:t,.mnts�NG.29.E.ka.ed.al tnxmEte.h[1G..24.ai.1�[C.Sp............
uue�ge.;.taltn�SB�..1.311Q.E.tax�axds.C,,.M..lOutlax�:'.a.Starye,.At Qutla�'s.Sxar�e.t;uana.LC.auta.SR.X�Q.i;.ga.1,B.miles..entraiace.xa.farw.. .
® Swine ❑ Poultry ❑ Cattle Latitude 35 01 53 u Longitude 78 00 57 u
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: ...................................................................................................................................................................................................................
Freeboard(inches):................A..............................34...............................................................................................................................................................

3
Facility Nt"ber: 31-299 Date of inspection 3/3/2000 Printed on: 3rz3/2000
..-
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 tbreat, 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/unprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive 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?
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?
-N&iriolahiris: dr:defrciericies-ivere:rioied:du'rink ttiii-Oiii.: V-ou �vffreceive:n hirhier:
.........................................................
' e�n'rrp.�iriwiticA ahrliit't-iiifi•i�acit.'.'.'.'.'.'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Freeboard Check. Facility looked goodl
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No '
❑ Yes ❑ No
❑ Yes ❑ No
ii Y•i:<ii "vr4:{{.:{{{{G:::{.:�:' �{{.',{i::%.}:::5.:{irk?�::fyi'.`•j::U�:::hi�:A:i:.:{i:.r �r4:.' :i;UF ... v.W.+.-i::'il i�i.iG... ::.: :{.:-ii: [Reviewer/Inspector Name
f:.C�'lltN
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.i: 4:Sr�:i ::'r'J: •''%4:. '>`:G:•.
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r:.,..�;.„ �::�<•:;:s�<;..}:x<::�,: r �:::r:::.:.:{,�:.:{:.«;{�:.:.: v � �<>::£xz::�'s::�r ..,.: ,x.:,.:
brae .r.:• ..r..r: •:r.-.: :.§ :.r,: ��?�> :..u.:., .t.:. ..>...,

Division of Soil an,Water Conserv-fflation li,'OperationjReview !'t,`"' ' r
13 Division of Si l ani3"Water Conservation Compliance inispectioe
r i4al
RDivisiion of Water Quality - Complianee Inspection
- e v 1 q .,t F't JN,'�-
k'Other Agency,;- Operation Review, ,.' '', r r..r z,•. '�a u ' �,mF tr s..re , i• .''n f
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Tinie of Inspection 24 hr. (hh:mm)
© Permitted Certified ❑ Conditionally Certified © Registered [] .Not Operational Date Last Operated:
Farm Name :.L"s...... County "i"� .......................
....-.................................................................................. '................................
OwnerName:...............................................................................
....... Phone No:.............................................................
Facility Contact: .............................................................................. Title:............ Phone No
MailingAddress: ...................................... .......................................................................................................................................................:............ ..........................
tki.1.1
Onsite Representative:..w�,................................................... .......... ...... Integrator:..............,.............................................
Certified Operator:.._ ............. ................... Operator Certifi4cationNumber.
-pVatiyV of Far
Vell1!►l................................... k........... - ......... ....... ?.yG....a ........�........ 1........5.... •
...0.. 5 K.I r3 4.A.................................................................................. .......... ;
Latitude ' & .4 Longitude ' 1 49
i ;Number of Lagoons �— i ❑ Subsurface Drains Present Irl Lagoon Area [ISpray Field Area ;
Ho
ldmgfPonds`/ Solid Traps E:=_ ❑ No Liquid Waste Management System e
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d.• 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 RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O 'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5. Structure 6
Identifier: 1j
Freeboard(inches): ...............�....!........................n'.................................................... ................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3/23/99 Continued on back

Faci ity Number: 131 — ��J( Date of inspection
i
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 qr environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12, Crop type �Ts4. S6kI WrN
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 thcre 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?
0' �qv '• 61'0001s'O 001:i006es Were ngted. cto-Ofig OjS'Visit: Yoh wiil tieeeiye ii6 futthgr
corres• oridei� ' e: A6 ' f this visit.. . .
E E - f: t 3 - i (
Comments (refer ito question #� Expla4n any YES answers and/or any, recommeudaf>ans oars any other comme
[T�e�drawtri s of iaciht ,to better ex lath situaho' l 1 on addMA Ipages as gp j ns (use
� .., • ,.. nec
❑ Yes 5�No
❑ Yes ( No
❑ Yes �No
❑ Yes QrNo
❑ Yes K No
❑ Yes X No
❑ Yes KNo
❑ Yes [ZNo
❑ Yes 9 No
6-Yes ❑'No
❑ Yes gNo
❑ Yes ZNo
❑ Yes �No
❑ Yes CKNo
❑ Yes DqNo
Cl Yes j No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
<-_� 6�'_CL14 4f( � SzO�."5�GSS{ 1.
Reviewer/Inspector Name - ....6� •.: �_ _."�I��, . ; € E1-4.. ' ,r •r � '� - € ism `ilk 3 coo?
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number:3 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? ❑ Yes �o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 2fNo
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, ctc.) ❑ Yes 14 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ayes ❑ No
Additional Comments all or, r#ringS .��
T
3/23/99

x 13 Division of Soil and Water Conservation . [3 Other Agency x j`IN
�
` ODivision of Water Quality 22
RIM
O Routine O Complaint O Follow-up of DNVQ ins action O Follow -tie of DSWC review O Other
Date of Inspection 2 Z
Facility Number 3 1
Time of Inspection 24 hr. (hh:mm)
0 Registered 12 Certified © Applied for Permit E3 Permitted 113 Not Opera Date Last Operated:
Farm Name:... }a...,.1.S.. ..£ .... o�.cx.,r.>.......�.$.... ........ ... County:.. .u.t... ................................. A'.M.
Owner Dame:....... £...,n....................... ...5... ..t��..k.�.ti^5........................... Phone No: .... �...`.i.l..j�.�....�.�..�...`..�..�.�....il...........
Facility Contact:..........................:................................................... Title: Phone No:
Mailing Address:..... I. ... Q.�.1......... ........"-I ....................... ... t �
Onsite Representative:.... .n�,�... %.� n..5.. R..!►.�n... s .e..�� Integ_rator:..�A."..r.l ................................................
Certified Operator;..... .ti ire........: ..5.�..�. .. p . �....1..�,•�r..1 h...anri................... Operator Certification Number ,,,
Location of Farm:
E........ .11 .......... .. ...... ..... .. ............................
i i
Latitude E=oc Longitude �' �� `24
'-Desrgn:. ` Current . Design Current "n Design Cuirent
Swine $" Capacity Population " Poultry'" Capacity Population Cattle " :. Capacity Population
EaWean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
r of Lagoons /Holding Po;
_. s-.
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
x
❑ Other
Total Design:Capacity Zp b
Tota15SLW Q �p
'eneral
L Are there any buffers that need maintenance/improvement?
Subsurface Drains Present
No Liquid Waste Manaeen
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 gaUmin?
cf. 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?
Lagoon Area J© Spray Field Area
Svstem'
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
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?
7125/97
❑ Yes ® No
❑ Yes .® No
❑ Yes &No
❑ Yes No
❑ Yes ® No
❑ Yes 52 No
❑ Yes Q No
❑ Yes Qj No
❑ Yes IRNo
❑ Yes S. No
Continued on back

Facility Number: -
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Layons.11olding Ponds, Flush fits., etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Stnucture 1 Structure 2 Structure 3
Identifier: 7..... . I...
Freeboard(ft):.............................................................................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application t
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes S� No
❑ Yes R1 No
Structure 5 Stnicture 6
15. Crop type .....1a.e /.vc. W. 16. .................. .... ..q.x-CkA.V........ ....................
...............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does 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.violations or d6 t6eni des. were noted -during this: visit:• :Yoii'—MH •receive ii61Lirther :
:. correspondeice Ab:oitt 4his:visif.• : : .
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes BNo
❑ Yes V No
❑ Yes
®'No
❑ Yes
® No
0 Yes
❑ No
❑ Yes
No
❑ Yes
® No
❑ Yes
JR No
RYes
❑ No
❑ Yes R No
❑ Yes ®, No
❑ Yes lgkNo
1 W t x t I tL.a-�r, w o r 1L a w q t- ►� a� i .9,'� .,r S +M a. !.\ q ra.ti v. C-o v�� r 0 y p v r +
bS---, v1
227-•firl f'i 1# 1 g • Ir. o-d d t �t C ,n, rev--3 tt k:r_- t-v,t tz I rs,
c f v► }-via
t d. +0 e q iI I C, V� Z- 8 I to s
v�►- 4 a v-e.+ra le 1p - k +o i ,�v�w l 1 ,q ra ► ,. o V4,v-z tR-J a w .r �'� ° . Cu.., eA
�a laA fry. to 1�r V we. f't-+ e (I '(-ia n p
0 wi t D tr �t o�✓� t 4O t'G. L ML V �` p to-�n -j ait
0A. LL t ► "` wee -ass £ t i n u tr r a'-e..S a ✓� t �.! h.-�-a_ { w ytm
?h e". �^'+ a-N a. fs o Ind. a LC , a i w r v�+e -S 4 . U a tr r n n n l i r-, t4 e L, Ld ,�. rJl d r .s /, 5, 7 ,.
w, -N J c
Reviewer/Inspector Na 1 :s ;'
.". ,>a
Reviewer/Inspector Signature: Date: I
A 0 t i-� c.t. 0� .S t ne..'t Ca" d +-• .
I g.

® Division of Soil and Water Conservation'' .❑ Other Agency
❑ Division of Water Quality
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Foll6w-'iip of DSWC review 0 Other
Date of Inspection F 11/10/97
Facility Number 31 299
Time of Inspection 1000 24 hr. (hh:mm)
E3 Registered IM Certified ® Applied for Permit ❑ Permitted 113 Not O crxtionxl Date Last Operated:
FarmName: Dil tl�xl�.)E�tz�m.�St�L................................................................................... County: t?.uplin................................................ . .t.........
Owner Name: dg;tn........................... Step.htim.................................................... Phone No: 9.10:7293.n7.659 ..........................................................
FacilityContact: bma.Staphms................................................ Title:.L?flan................................................ Phone No:...................................................
Mailing Address: 1.62.6 awillc ts.Ril.............. :................................................................. W...maw...NYC.......................................................... 183.98 .............
Onsite Representative: ,Je .StGtts;lxp 1.dohs.GatlktulsA............................................. Integrator: Murphy..Family..FaGins.................................. ....
Certified Operator:,J.e;Ln..0.................................... Stfihbless.......................................... Operator Certification Number:.I�.1lS.�.............................
L,UCillfUll Vl fill"[Il: ..
F;t�m.t.la�atiuxt�.. f;�)�e.l]5..117..N.ta.!az9a :.ak.��ta.11gb�x,.xtt rn l�t,.nnt� ]YG. 1..la.�e,�e.af.ta�vn.�yt�eKa.�[. 2�.a�ntl.�ll:.,SO.............
a>A;rg,e,. x alue.,S.Fb. �.311(l.�.tasxa zcbs.lw�.M,. A u�tba�::s.S�tazc;.�1.t..f3.u1l;any's.Sxair.G:tux�n.Lt�.az�ta.�ti.. b�Q.t:.grx.X�>t.�nni�es:.a�akt:;4�ae�e..tA..faxna.. .
Latitude 35 " 0111 53 11,
Longitude 7i; ,'. .;AO s 57 64
® Wean to Feeder
5200
3350
❑ Feeder to Finish
[3 Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? F _
Discharge originated at: ❑ Lagoon ❑ Spray Field [];tuber
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (fyes;`notify DWQ)
c. If discharge is observed, what is die 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? r
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste inanageme:nt system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect atthe time of design?
❑ Yes H No
❑ Yes ❑ No
E] Yes ❑ No
❑ Yes
[]No
❑ Yes
H No
❑ Yes
0 No
❑ Yes
0 No
❑ Yes 0 No
T Did the facility fail to have a certified operator in responsible charge:?
7/25/97
❑ Yes 0 No

jPacility Number: 31-299
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
M No
Structures (Lagoons,I-Ioldint Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Cj Yes
M No
Stnicture I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: H1.1............................H1.2..............
Freeboard (ft): ............. 15.$............. .............11.7.............,......................................................................
...................................
.... ......................................
10. Is seepage observed from any of the structures?
© Yes
® No
1 l . Is erosion, or any other threats to die integrity of any of the structures observed?
[] Yes
No
12. Do any of die structures need maintenance/improvement?
Yes
No
(If any of questions 9-12 was answered yes, and the situation posesAP
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level riiarkers? ❑ Yes M No
Waste Application
14, Is there physical evidence of over application? © Yes M No
(II' in excess of WMP, or runoff entering waters of the State, notify DV 6.^
15. Crop type ........................ NQ=............... ......... ................................................ :..................................................................... ..................................................I
16, Do the receiving crops differ with those designated in the Animal Waste Management flan (AWMP)'? ❑ Yes M No
17. Does die facility have a lack of adequate acreage for land application? © Yes M No
18. Does die receiving crop need improvement? © Yes M No
19, Is there a lack of available waste application equipment? ❑ Yes M No
20, Does facility require a follow-up visit by same agency? [] Yes M No
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? [] Yes M No
22, Does record keeping need improvement? M Yes 0 No
For Certified or Permitted Facilities Only
23, Does the facility fail to have a copy of die Animal Waste Management Plant readily available? ❑ Yes M No
24, Were any additional problems noted which cause noncompliance of die Cet•tified AWMP? ❑ Yes M No
25. Were any additional problems noted which cause noncompliance of the Pennit? ❑ Yes M No
_,...,.., ........... .. ...... .
•No• violati os' or'd'eP'CiertEies•wvere'ifoted'duyipg• rthis•�iSit� ;1'otl •M1i'ruelve •nb fort -her., • ,
::::carres �ondeitce Aouf this:visati::: ; . ; : ; :: ; ; : ; . ;
done with Mr. Godbold.
Should follow WLIP to get full credit for N application on fields. Also keep records to show what is being irrigated on fields to
hydraulic and agronomic loading rates.
7/25/97
ReviewerlInspector Nameht! 1V1,it`Lgcf,1�
...:. .. ...... .. ::..... . '.... y < :::. .i..y:.. NZ......
Reviewer/Inspector Signature: 4 ,, , Date:

119 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection (,
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Farm Status,
' 0Certitied ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated : ............................... ..._...... ......... ................................... ........ _...... ................... .................... ......
FarmName:... ..1.. ..r�..n, .� �..... .Y. ..... .. d... ...W............._....... County:...D.y.�..Lasn..... ..._..................... .�. ►..�.� Q.
Land Owner Name: .............................. Phone No:.12.!. q)..............................
FacilityConctact:.................................................................................. Title:................................................ Phone No:.........................................................
Mailing Address: ..... 1..6 .6...... . ...... F_.j .......................... ................. ... 1n.�.�.. r �S .rrt t.r....!1........... ....... ................ 213..IS...
OnsiteRepresentative: .... �� �n....5 R.r�..�n.4nra.S...................................... Integrator:...M.u.A__f..1_7..... ........................... .....................
Certified Operator:...........L .................. ..... 51ef.11.a.4i............................. Operator Certification Number: ..................
Location of Farm:
Qus..... . d..S ....... �.i.�. .......a .....5.. 1. ... ..I...t...... .. .. Sc c.�s �.. ra.a.....4... ......Z....... rn..i...�..�e �..... .a.x..�.......... 4
............... ............................. ............1.. ............. ............ ................ ....................
Latitude ©a 6 53 " Longitude ®` 6 64
Gei;lgral
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ff No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes @ No
c. If discharge is observed, what is the estimated flow in gal/min? tJ [A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes RNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes &�No
4/30/97 maintenance/improvement? Continued on baek

FaeilityNumber:..j1....... —.2r...°(.1
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes J, No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons andLor Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
...........4............... .............. ............................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the -structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Wa5le Applicatiop
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure 5 ' Structure 6
15. Crop type ........ .Sscus.a..lA......................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For -Certified aciliti 5 Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
• W o Y 1� a,. c a +r rt-f-J-,, w e e-ci
2 4 - Cr t,-. w 'r- r e.�n`1 w a S }-tr s w'P
IA a LE s'j r-e. to Y-e.¢�1 � rl o v. Gi Q-" b o y .
Reviewer/Inspector Name c aE ;:'
Reviewer/Inspector Signature: .1113 'er Date:
❑ Yes ®,No
❑ Yes ® No
® Yes ❑ No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes KNo
❑ Yes ® No
® Yes ❑ No
❑ Yes Z No
❑ Yes Eff No
❑ Yes KNo
❑ Yes 91 No
❑ Yes KNo
RR Yes ❑ No
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. ?
• DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7', 1995
14 L `1) Time:
Farm Name/Owns
Mailing Address:
County 4 ,jo I I
Integrator: vvPhone:
On Site Representativa I Phone: 9/D ap3 7 9a.
e
Physical Address/Locati6n:5Q 13 Ol a_ j242 .V L 10 x„ i �4 2,­e'_f'Lk4.4 6 x. M, re
Type of Operation: Swine l/ Poultry Cattle ' y UA 5 ry
Design Capacity: CL Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 -r° _Cjj_' Longitude:-7 a°
Circle Yes or No
Elevation: Feet
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard:
Ft:_ Inches
Was any seepage observed from the lagoon(s)? Yes or�Was any erosion observed? Yes or&
Is adequate land available for spray? diJG rAo Is the cover crop adequate?De or No
Crop(s) being utilized. -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? §or No
�3-/o q�_
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orQLQ;
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 0(9)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o N> 5 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)? 9r No
Additional Comments: H40 yciaoil�OJt7_
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.