310382_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

r/
Type of Visit: 0 Co Hance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 15 r0 Arrival Time: I a Departure Time: IL! :J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: -
Facility Contact: Title: Phone:
Onsite Representative: 0 ("--c S L"� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: 1 0
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
an to Feeder
Feeder to Finish 'ZZ 4S- Z 59
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Desigu Current
Capacity Pop.
Non -La er
El
Dairy Calf
Dairy Heifer
Dry Cow
Farrow to Wean
Design Current
Dr. P,oul Ca aci_ P,o ,
Layers
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 0 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 ❑ o ❑ NA ❑ NE
[:]Yes
[' ❑ NA ❑ NE
❑ Yes rj"No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Faciti Number: -3 9-Z- jDate of Inspection: 7
1p
Waste Collection & Treatment
Yes
o
NA
NE
4. fs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑
❑
❑
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ko
❑ 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 gj'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 .ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ 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 Z] 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 [2rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2-No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the.Certificate of Coverage & Permit readily available?
[:]Yes P!fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
D. 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 . No
❑ 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 EyNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes H No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

�J
Facili Number: - Date of Inspection: Z 1 ib
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25�. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo [DNA ❑ 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 2e ! f A, el N/toe1(l 1, C .'ecv r2s
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 FD/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/Stomge 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
0�
❑ NA
❑ NE
❑ Yes
�xo
❑ NA
❑ NE
❑Yes
ON
DNA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes - No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or anyother comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
rz-,,� o
gam--
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
CAL � -c hi
a�
Phone: [ �� I
Date: Z % 5— l6
21412014

(Type of Visit: • (DC
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Complaint O Follow-up O Referral _O Emergency 0 Other _ O Denied Access
Date of Visit: Q Arrival Time: Departure Time: O County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 7 �tYw� Integrator:
Phone:
Certified Operator: Certification Number:
,Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design C+urrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
can to Finish Layer Dairy Cow
can to Feeder
Non -La er
I
Dairy Calf
71
Feeder to Finish j GL
Dairy Heifer
Design C*urrent Dry Cow
D , P,oult , C•_a M P,o , Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes 4
No
❑ Yes No
❑ Yes 9No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA [:3 NE
Page I of 3 21412015 Continued

Facili ,}dumber: - -3 Sr-L I jDate of inspection: ! i-0r—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes <o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 U/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
or
7. Do any of the structures need maintenance or improvement? Yes o❑ 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 W
No ❑ NA ❑ NE
maintenance or improvement? i
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [7 No ❑ NA ❑ NE
t9
maintenance or improvemen .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 0No ❑ 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
UNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ NA
D 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 16No
❑ 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 L1J No
❑ NA
0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [J No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facill dumber: 1_ 3 Date of Inspection: ji zo l 57
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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
E211 o
❑ NA
❑ NE
❑ Yes
❑ No
fNA
❑ NE
❑ Yes �No
❑ Yes 71- No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain:any YES answers and/or; any additional recommendations or`any other comments.
Use drawines of facility to better explain situations (use additional naves as necessarv).
7� (ucergs
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C` &C. b 9 Z_/ . Q k k14'
Phone: �( I+ 7 3 p/
Lj
Date:
21412015

Type of Visit: QTompliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 L f Arrival Time: I 44.'D5 P44 Departure Time: $L � County: Region: W Q
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Phone:
Onsite Representative: Integrator: qp A
Certified Operator: Certification Number: { - ` v �j
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. WeE Poultry Capacity Pop.
Wean to Finish La er
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean Design Current
Farrow to Feeder D . P�oult . Ga aci P,a
Farrow to Finish Layers
DairyHeifer
D Cow
Non-Dairy
4
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 PrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - '= Date of inspection: 1211�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ej No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑NA
❑NE
8. Do any of the structures lack adequate markers as required by the permit?
No
❑ YesgNo
[DNA
❑ 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 ZdNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
: ❑ Yes KNo
❑ 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 EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes e No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable D Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps [:]Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes XNo
[—]Yes 0No
❑Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes L2rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 3 - Date of Ins ection:1-3 72W
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f'No ❑ NA 0 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 � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6No ❑ 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?
❑ Yes KNo ❑ NA ❑ NE
[:]Yes RfNo ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes
[�(No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name: ��ST��1dR,Vi� Phone:
Reviewer/Inspector Signature: T;oDate: 22w/
Page 3 of 3 21412011

Type of Visit: RFompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �$ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: )1 ' County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: bg(nes
Certified Operator: A5H6E—_U,5
Owner Email:
Phone:
Phone:
Inteeggraatto�,r:
Certification Number: 9130659
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desig4
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
Layer
Design Current
Capacity Pop.
Cattle
Dairy Cow
Dairy Calf
Design C►urrent
C*apacrty Pop.
Wean to Feeder
Non -La er
I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
1) . P,o_ul
Design Current
Ca aci P,o
Dg Cow
Non-Dairy
Farrow to Finish
I
ILMers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 )q No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes []No
❑ Yes No
❑ Yes Na
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '8 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): IC), 5
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 V No ❑ NA ❑ NE
waste management or closure plan? T�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes { No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
�
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
PSI
LJ_G
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.
Ud
❑ Yes )2�No ❑ NA ❑ NE
❑ Yes -No ❑ NA ❑ NE
❑ Yes 9_ o ❑ NA ❑ NE
❑ Yes b6No ❑ NA NE
❑ Yes [,72�Vo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 15LNo ❑ NA ❑ NE
OWUP QChecklists ❑+ Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
Q Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ WAte Transfers
0 Rainfall ❑ Stocking Q Crop Yield 0120 Minute Inspections El Monthly and 1" RainfallInspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
Q Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. bid 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 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 19
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [—]No kNA ❑ NE
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] No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
�[
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes V�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 '0 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
W,H
7 /O�/ `tart. �-+r)A1
Lq
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q ld --19 2u g'4
Date: g1CQL4ya
21412011

' ` i'vision of Water Quality
�FME Number - -�Sa © Division oanr C f Soil d Wateonservation
•0 Other Agency
type of Visit: 1ACompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[teason for Visit: Routine O Complaint O Foliow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit:-� Arrival Time: O0r Departure Time: County:/�/ Region:
Farm Name: p' p� l 3 3� go xs ✓ S ! —1to Owner Email:
Owner Name: YkC__S7,qGC_ P Q Q m� J JIB e, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �� A j\k e-S Cog nA iS Integrator:
Certified Operator: 1r, 6 V I N _ N T i y `<ncg_ L CeQiicatt' Number:
Back-up Operator:
Certification Number-
Location of Farm: Latitude: Longitude:
9 2 9 o_TS
Design Current Design
Swine Capacity Pop. Wet Poultry Capacity
Wean to Finish La er
Current
Pap.
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Design
1) , Pooutt . Ca aci
La ers
Current
P.o
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Uther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PkNo ❑ 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 ; No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: I jDate of Inspection: J
Wdste CAction & 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 ❑ o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: y- j - r
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 0 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 rNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �C�No ❑ NA ❑ NE
❑ Excessive Po riding ❑ 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.
❑ Yes 0 No
❑ Yes of No
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
QWUP ElChecklists QDesign 0 Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes2s�e
No ❑ NA ❑ NE
❑ Waste Application [] Weekly Freeboard [] Waste Analysis Q Soil Analysis ❑ Waste Trs[] Weather Code
Q Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilitv Number: '? 1 - 73 Date of Insaectiun: rr 11
24.-Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes kNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes X
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 1A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes] No
❑ Yes No
❑ Yes No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q fn-'?- &' -_?30�
Date: 1'kz %I _
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D d �� Arrival Time: �a�t I� Departure Time: County: U Al Region:
Farm Name: �1- � 3 ') OUSES � `i - j � Owner Email:
[�
Owner Name: 1`2FST� Y1i11, I%S/C • Phone:
Mailing Address: r !��X ` O �Ur / �' 99199
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e 0 6 Longitude: 00
0 i
Design,,Current_,
Swine Capacity Po0tilation Wet Poultry
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder �: ❑ Non -Layer
Feeder to Finish �.
❑ Farrow to Wean
.,� Dnry�Poultry�^
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharp,es & 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?
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
No
❑ Yes kr
_4XNo
❑ NA
❑ NE
ElYes
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ NA ElNE
a. If yes, is waste level into the structural freeboard? ElYes El No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Ljcjcm^l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J<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 XNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require []Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
t0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ICJ No
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �TNo
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) 1AILA. Ctq l ) t 0-11—
❑ NA ❑ NE
❑NA El NE
M
Q
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
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
1kr No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
'No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�(No
❑ NA
❑ NE
Comments (refer torvqueshon #} Explain 'any YES answers and/oi any'recommendatians,orany'vthercomm nts.f
Use dravtmgs'of�facilit, to better'explain"situations {use addtho al pages as necessary)
Reviewer/InspectorName
. Phone:
Reviewer/Inspector Signature:. Date:
Page 2 of 3 12128104 Continued

FacilitrNumber: —3891Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 11� 111
❑ WUP 0 Checklists El Design 0 Maps ❑ Qther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ VAste Transfers ❑�nual Certification
Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections El 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
ANo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
%No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air. quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
f<No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
bNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
L41 )
51s1w 1,9
1)131,o C_),Oa
Q.�r� GA(AeR_A � D�s �a 0��
l�
_�coS-GKo��N�S
Page 3 of 3 12128104

Facility Ntinber 31
3�
Division o%Wate
Q Division of Soils
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �[n� Arrival Time: ® Departure Time: County: U%v Region:
�
Farm Name: 1 ` 9) S l�laus�s ) L/ —) tO Owner Email: y�
Owner Name:' WE5M9: �I;:' m s %Nc • Phone: 91
Mailing Address: Y '0. QSoX L4IS o CA�.Al7—UN G �0 sor —I
Physical Address:
Facility Contact: n Title: Phone No:
r'�rny Onsite Representative: �7N{��S `-4I Integrator:
Certified Operator: 11£U1 A/ QQFAT [Y)6QV_E Operator Certification Number: �d
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 c 0 1 Longitude: =°= 6
Design Current
Swine ;Capacity P.opulat-ion
De
Z'�'et Poultry,
❑ Wean to Finish
< ❑ Layer
❑ Wean to Feeder
JE1 Non -Layer
Feeder to Finish
DryPoultry,
.n
`
El Farrow to Wean
2
❑ Farrow to Feeder
" El Layers
❑ Farrow to Finish
❑ Non -Layers
�-
❑Gilts
El
=s
El Boars
Other
❑ Turkeys
: ❑ Turkey Poults
❑ 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)?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
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 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes
KN o
❑ NA
❑ NE
12128104 Continued

»acaity'Number: 3 ) 38
Date of Inspection 13DQIQJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V 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: C6=061
Spillway?:
Designed Freeboard (in): l�^S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ 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 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA [INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? YY�r►�`�`
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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) Hu-j-jtuul LL
)LL
V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes No
17. Does the facility lack adequate acreage for land application? ❑ Yes No
18. is there a lack of properly operating waste application equipment? ❑ Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments,(refer to question:#)Explam,an'yxYES answersandlor any recomendations�ar.any other comments.
ty to 2Use drawings of facilibetter explain situations;>(use additional pages as necessary,): _
4pgb9 1. S
N/9D/09 .1•
Reviewer/Inspector Name Phone:
ReviewerAnspector Signature: Date:
�3Cj)09
Page 2 of 3 12128104 Continued

Facility Number: 3 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropirate box. 0 WUP ❑ Checklists 0 Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [:1 NA ❑ NE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ /aste Transfers ❑ Alnual Certification
EIRainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections E]Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?'
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
VNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ic/ 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
ANo
❑ NA
❑ NE
Additional Comments and/or Drawings:. . _-
Page 3 of 3 12128104

_Division of water Quality
Facility Number Division of Soil and Water Conservation
---- -' -- -- -- Q Other Agency
Type of Visit XCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �f Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Em�b 8: 1 Arrival Time: Departure Time: � County: U-A/ Region:
Farm Name:
Owner Email:
Owner Name: 0 • ►` - C .1` � SAD 70 S m(Lc— Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: M S LA Ik Q
Certified Operator: KF U I AI g&ENT MC>0qJ,--
Phone No:
Integrator:
Operator Certification Number: 9 1R-/ o—+S
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: = o = 6 Longitude: = ° = i
g.. g
Design. Current-,: Design" Current Desi n Current
Capacity .Population Wet Poultry Capacity Population Cattle. Capacity .,Population. ,
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other IE
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ 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?
❑ Dainy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod
I
Number of Structures:.''_' r
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
ElNA
❑ NE
❑ Yes
INo
❑ NA
❑ NE
12128104 Continued

Fc ility Number: 1 � 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: IGF ) IP
❑ Yes ANo
❑ Yes [!No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?: Q
Designed Freeboard (in): I
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 11
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) IN
4. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement? 11
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
[2 No ❑ NA El NE
Ind No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages. as necessary):
Reviewer/Inspector Name F (TEl R Nr Phone: 9 )()
Reviewer/lnspector Signature: Date:
Page 2 of 3 12128104 Continued

acility-Number: — Date of Inspection
Reauired_Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropriate box. ❑ VVUp ❑ Checklists ❑ Design ❑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 ,V No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
4 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q"No
❑ NA
❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CVNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
TNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C, No
❑ NA
❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
RNo
❑ 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
JP 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
- D] 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
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
J0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 31 3$y 0 Division of Soil and Water Conservation /
O Other Agency v
Type of Visit %f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: (Z.ves Departure Time: C7 County: _ DUQ�5. Region:
Farm Name: Owner Email:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �_TAW16S i AIL4N
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title: Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , = Longitude: = o = , ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish aaGL� a?.tTc�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
Pullets
Poults
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
Capacity Population,,.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
CJ No
❑ NA
[INE
12128104 Continued

Facility Number: — 3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: L.A drwt�...J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LA 1
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 El No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 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 EP o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IJ 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 C1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
21 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Nj
ClNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
,L�'J,
h o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerlInspector Name Jo 1-11-) rAakxct �A Phone:t'gtZ$) I
ReviewerlInspector Signature: Date: I
12128104 Continued

Facility Number: 31 — Date of Inspection 1�
Ue aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 12 NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IJ No ❑ 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
B No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis -❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Main Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
T_5I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LJ N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El
L'7 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
21No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Io ❑ 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
El Yes
,.
2No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑
NA
�No
ElNE
Does facility require a follow-up visit by same agency?
El,�,33.
Yes
❑ NA
❑ NE
Comments and/or Drawings:
12128104

$Z
Type of Visitpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g O Arrival Time: // Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: S,N1ES LAmd
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
�o
Latitude:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Longitude: = ° a
Design Current
Design
Current Design
Current
Swine C►►opacity Population Wet Poultry
C►►opacity
Population Cattle Capacity
Population
❑ Wean to Finish ❑ Layer
❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer
❑ DairyCalf
Feeder to Finish
2AA. -
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑Non-Laers
❑ Pullets
❑ Turke s
❑ Beef Feeder
El Beef Brood Cowl
❑ Boars
Other
❑ Turkey Poults
❑ Other
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes L_I No ❑ NA ❑ NE
El Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
El No
❑ Yes
El NA
El NE
❑ Yes
zo
ElNA
ElNE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
-4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:6go#J 11-11a
Spillway?:
Designed Freeboard (in): IfIr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EJNo El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 EX' ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L1INElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 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 Cad 3 & d 1 vzj [, T
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
,,2{2
L—�(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any, recommendations,'or.` any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
D...... ') -r 2
Phone / ro
Date: �lr
11
12128104 Continued

Facility Number: EIL; Date of Inspection $ J
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
,,�'
�E No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
aeo
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
/No
❑ NA
❑ 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
NNoo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
l
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Co
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑/ ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�Ko ❑ 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
Va ❑ 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
ONo, ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 10 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit J6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: // Arrival Time: �Departure Time: County:
Farm Name: Owner Email:
Owner Name: - A;��(.v S G Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Title: Phone No:
Integrator: d e5 ce
Operator Certification Number:
Back-up Certification Number:
Region: ZWM619
Latitude: 0 c = g Longitude: = ° = F
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1 L 0 Non -Layer
Other
❑ Other - -- -- -- —
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: U1
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
1ZNo El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
YNo
[]NA
❑ NE
12178104 Continued

Jv ,
Facility Number: Date of Inspection 7
/
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /`I -/ b
Spillway?: N20
Designed Freeboard (in): 1Vr _
Observed Freeboard (in): 3e
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outsiiddeef of Area
12. Crop type(s)
13. Soil type(s) Hrf /V©
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
, ❑ Yes �No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes IX No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes jj�No
❑ NA
❑ NE
Reviewer/Inspector Name rV1V I Phone:
Reviewer/Inspector Signature: Date:
12/28104 Continued

t'
Facility Number: Date of Inspection
Required
I
Records &_Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 0 No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 'VNo
El NA
El NE
the appropirate box. WUP Checklists
ElEl❑ Design ❑Maps ❑Other
//
21.
Does record keeping need improvement? If yes, check the appropriate box below.
,.,J �
El Yes VNo
❑ NA
[I NE
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis El Soil Analysis El 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?
J�z
❑ Yes p6No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
/�No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
VrNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes IVNo ❑ NA ❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1� No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�(No El 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
X No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
• ❑ Yes
LNo ❑ NA
❑ NE
Additi;ooal'Cotnments and/or Drawings:.
..:. .. .
12128104

Type of Visit aCo Hance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number 3
Date of Visit: 7 a Time: !3 6 a
Q Not Operational Q Below Threshold
e tted d Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above/Threshold:
Farm Name: . _ . ___ _ _ __. __ . ._ County:!PI:T�✓
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No: W .__....._
_... _.Phone No:
Integrator. _..,,,GCL C5±q &1 ,,,,,,___ . _ , ______
Operator Certification Number._
0 Swine ❑ Poultry 0 Cattle 0 Horse Latitude • 4 " Longitude • 4 99
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 E4
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes U4is
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier +
Freeboard (inches):
12/12103 Continued

Facility Number: 31j Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes/No
seepage, etc.)
6. Are there structures -on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Q No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefimprovement? ❑ Yes C14o
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes Leo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes 2<0
elevation markings?
Waste ApOcation
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,7No
�.,
i 1 _ Is there evidence of over application? If yes, check the appropriate box below. El Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type MMA.- tit- �E 11�1L LG� 1% 0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes L71Vo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EPCO
b) Does the facility need a wettable acre determination? ❑ Yes ❑-iQo
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes [�
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes io
liquid level -of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Io
19. Is them any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, andlor 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 o
Air Quality representative immediately.
('AAV J - I IftE-P,
Reviewer/Inspector Name
Reviewer/InspeeWr Signature:
❑ Field Copy ❑ Final Notes
Date: -)/7-1 / 6
1282103 Confinued

' Facility Number: M — M6 Date of Inspection
Required Records & Document-,
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ONo
22. Does the facility fail to have all components of the Certified Amoral Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �:yo
❑ 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 040,
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes �io
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, fiuboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative? ❑ Yes OXO
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 02 CO
NIPDES Permitted Facilities
30. Is the facility covered render a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑ 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 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112M3

IType of Visit A Compliance Inspection 0 Operation Review Q Lagoon Evaluation I
Reason for Visit 2(Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted O Certified 0 Conditionally Certified D Registered
Farm Name: nn /�
Owner Name:
Mailing Address:
Facility Contact: /] %�, Title:
Onsite Representative: A Q . _AL 7'.z
Time:
Date Last Operate
dhove Threshold:
County:
Phone No:
Phone No:
Integrator: & !< .
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` 0" Longitude 00 6 0
to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
W
Other
uid Waste
Present
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
Area JU Spray Field Area 1
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes WrNo
❑ Yes W1No
❑ Yes 0No
Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 3173 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ire/ trees, severe erosion,
❑ yes
0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed through a waste management or
❑ Yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
J6 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�21 No
1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type
B. Do the receiving crops differ with those designated in the Certified Animal Was a Management Klan(CAWMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
jo No
c) This facility is pended for a wettable acre determination?
❑ Yes
0 No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
JO
ff No
Required Record§& Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
V No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Z No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VI No
24. Does facility require a follow-up visit by same agency?
❑ Yes
V.No
V.
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�Co menu (refer to �quesbon � r'Explatn any'Y�ES answers andlor� nammendahnns o_r any, other•comments.= .�, =y °
FUse rlrawing`sof£faci)ityto better ezplain,situations'"";(use add oaaUp germs asne`cessary) ❑Field Copy ❑Final Notes
1, b tDOO TR DN VO-Zg A_oiz l�plo �zo
l
0070ZF4z aOOZ_ s�F-HO OF 2.1 Q,-
Pori 1� ����ov O AsT, PfoAj, y5z5 Ar4 o ? l rRorn 102
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: d
05103101 Continued

f '}
t
Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation? 10
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VrNo
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 u No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes PfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings: a< �t. ;�, W - �� :� ' v - -� �� , I'' .,
1
©RDC12,
I
1 '��._ I 1
05103101

Type of Visit 0Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 Z Date of Visit:
0 Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: �-a vo 'qr V'_
Owner Name: © ram F 1' z t n Y,11"(
Mailing Address:
Facility Contact: fj Title:
h^
Onsite Representative: t� h 2 L R
Certified Operator:
Location of Farm:
� Time: �
Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
County:
Phone No:
Phone) No:
Integrator Pr-C-s bpi
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 0 " Longitude • D u
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
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.ETNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ qqI
Freeboard (inches): 21.5
05103101 Continued

Facility Number: -3/ — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El 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?
El Yes ZNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes PNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ZNO
Waste Application
10. Are there any buffers that need maintenance/improvement?
El Yes No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN El Hydraulic Overload
El Yes ONO
t
12. Crop type Re;r+r'l �C�4 FAj4y,-e j �✓`1G i� 6,,4 �► v►/!1 of -ro!4 )iyJ G O ''1
4P e4,N
,h,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ANo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ,YJ No
b) Does the facility need a wettable acre determination?
❑ Yes 0 No
c) This facility is pended for a wettable acre determination?
❑ Yes 1Z No
15. Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment?
IONo
❑ Yes WNo
Required Records & Documents
/
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes ,rNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes P NO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ONo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes j2rNo
24. Does facility require a follow-up visit by same agency?
❑ Yes 1 0
25. Were any additional problems noted which cause noncompliance of the Certified AIAW?
'1
❑ Yes IETNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments.(reier to giies#ion #):= Explain any YE3 answers and/ror any TecommeodstEoas or any other comment
Use drawings of, facillty to bettenezplatn_sititation (n�:additioiial pages as necessary) ^_ ' El Field Copv El Final
Notes�
rJ. P Jec,S e r4gr-nve sq fl ,'► _) s 'fi'Oe A Je9400n -
Reviewer/Inspector Name O!l:�r•v 9 [�:
Reviewer/Inspector Signature: Date:
05103101 Continued

4 1'J
Facility lumber: 3 j - 3A Date of Inspection !
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0\o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes 7No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )Zvo
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 ON
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional --Comments and/or=Drawings:' '
05103101

tvision of Water Quality,
• 0 Division(if Soil and Water Conservation s
Q
Other Agency _
Type of Visit ,,,o Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 'Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Uate of ViSIt: 1 Q 1 Time: E= Printed on: 7/21/2000
FFacility lumber 3 ,� Z
Q Not Operational Q Below Threshold
0 Permitted 0 Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..............
Farm Name: ��I
.............. ---.-.-.. "I ............................. .......................
Q 1
OwnerName t.................................... Phone Na:-....._............................-_....--......................-.-..........-.-......
.................................... Z. z. r:
Facility Contact: ..............................................................................Title:...-............ Phone NO'
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: ,•--------------- !. ,-,-.............................................. Integrator: -,.--,.----,-- -
Q' I ZZ Q Pl��'�ct E'
Certified Operator:,,----„-„--,-,--„----------------------------- -, Operator Certification Number:,--„-.
Location 'of Farm:
Swine []Poultry []Cattle []Horse Latitude �' �� �« Longitude �• �0°
Design Current Design Current Design . - :Current
_- tionCa c¢
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish L ZQ ❑Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total i;k
Number of Lagoons
Subsurface Drains Present
❑ L>�^�►n Area
Spray Feld Area
❑ No Liquid Waste Management System
Solyd;Traps
Discharges & Stream Impacks
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ElOther
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed- what is the estimated flow in gal/min"
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................I ..... ............ .................................... .................................... -.................... .......... -....
Freeboard (inches): 7 j
5100
❑ Yes J? No
❑ Yes"&No
❑ YesNo
❑ Yes o
Yes�rfl
❑ Yes �Q No
❑ Yes�No
Structure
Continued on back

Facility Number: 3 —_79Z Date of Inspection 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�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 �to
(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?
h. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �r^VCR�i �otr�u� ,.�i'17,7I r e;,- ntCoY 11Whe�,SDwvecr,S,S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: �!Vo yiblati6ris ©r• &flciendbe g were n6ted dirrttig this' Visit; • Y'oif will •i-eeeiye fib further -
correspoiidence. a�otiti this .visit. • • • • • • • • • • . • • • . • • • • • •
❑ Yes ❑'�io
❑ Yes XNO
❑ Yes )2(No
❑ Yes ?'No
❑ Yes. G3"No
evic'— l i'14e7
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNNo
❑ Yes No
❑ Yes;eNo
❑ Yes,tfNo
❑ Yes �No
❑ Yeso
❑ Yes fif'No
❑ YesVfNo
❑ Yes 'P440
❑ Yes�No
❑ Yes �IVo
Reviewer/Inspector Name 0 2trl/aG
Reviewer/Inspector Signature: f%
Date:
5100

Facility Plumber: Mite of lnspection nted on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ YeSXNo
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 hio
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 _2fNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes GI'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes /❑ No
[Additional'.Comments an orDrawings:.
J
5/00

0 Division of Soil and Water`Conservation'-Operation Revrew� __ A
rr D Division -.
on of Soil and Water Conservation -Compliance Inspection
T' Division of Water uali Com lance Ins eetion.
EZ, Q ty p p
[]Other.' =Operation
IG(Routine O Com laint O Follow-up of DWQ inspection Q Fallow-u of DSWC review 0 Other
Facility Number 3 3$ 1 Date of lnspeclion —�1—
t'itue or Inspection Q 24 hr. (hh:mm)
(Permitted [3 Certified [3 Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: County::........
.rr� �c:r.-�......................................................... :-...........
Owner Name:...........:.. .. ................../.2.R: ....................--.-- Phone No: ...l�lJ.f-G!.. �................. ... ..
Facility Contact: ..t 1..: r��..:.... �(12Z.4i.t�Gt<.- ritle:......QKs............................... Phone No: �L.w..�1�.-�a..?..-g
{{
,Nlailing Address: .....................................................................................
........... ..........................
Onsite Representative: Z �� Integrator:........e..........................................
d .: �1...............................-..-............C.....sf r
Certified Operator ...........JM.............................. .���.(z1 (? .............. Operator Certification Number:../.�,/,�(/
Location of Farm:
r....................................................................................... .... ...........................................................
Latitude ram' �� ��° Longitude
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
Z2,C� j
JE1 Non -Layer
I
JCI Non Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SS
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. Ii' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon systern?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: � �!
Freeboard (inches):
1 /b/99
Structure 5
❑ Yes gNo
❑ Yes KNo
❑ Yes KNO
,VIA
❑ Yes! [VNo
❑ Yes QikNo
❑ Yes NN 0
❑ Yes kNo
Structure 6
Continued on back

Facility Number: — Date of Inspection
6. Are-tittere structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �f No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Roes any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste ADDlieation
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ANo
11.
Is there evidence Pf over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type (i
13.
Do the receiving qVps differ wit ose designated ik4CeidiedAnimal Waste Management Plan (CAWMP)?
❑ Yes
qNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[vNo
b) Does the facility need a wettable acre determination?
❑ Yes
y�No
c) This facility is pended for a wettable acre determination?
❑ Yes
qNo
15.
Does the receiving crop need improvement?
❑ Yes
ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
JZ 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
IRNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYesANO
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
XNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
jXNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
iffNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0No
0: N6.yi6laii6ris or• deficiencies -*ere noted d&iiiii �his:visit:. Y:oit'Wiil-reeeiye iio fui-thgr
corres ondeirce.about this visit. ..... . . ........ .... . . . .
Comments {refer to question #): Explain any YES answers and/or any:recotnmendattons or any -other comments:.
Use drawings of facili Eabetter ex la�ii.situations: use additional a es as rie"tessa
.—_ p_g ry)
i ri. I? _ -
•
Reviewer/Ins ector Name mm'
Reviewer/luspector SignatuSW—{1 �f� j/+ p� Date:
3/23/99

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i-e. residue on neighboring vegetation, asphalt, ❑ 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 J6No
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 KNo
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?
..._[Additional_ Comments ari or rawm
3/23/99

13 Division of Soil and;Water Conservation _Operation Review _
r t D Division of Soil and Water Conservation 'Compliance Inspection
® Division of Water Quy Compliance L�specdon -
..._ (] Other Agency" Operation Review ` 73
9 m _ '1
LID Routine 0 Complaint 0 Follow_ue of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number 3 Z Date of Inspection
Tinie of Inspection Q 24 hr. (hh:mm)
11 Permitted r] Certified 13 Conditionally Certified [3 Registered [3 Not Operational Date Last Operated:
Farm Name: O T t y.vi Count U n
y ,
...fit...m............................................................... ...V' .*........--- ................
Owner Name:.......Q......r.--...-.. -s Z�'1!' }...U...'................................. Phone NweIr IQ)...... .q. .......I..z.'...g..a......
Facility Contact: .............................................................................. Title:
Mailing Address: ....................................
/� Q) r 1
Onsrtc Representative.[J ,
Certified Operator:
Location of Farm:
Phone No:
.......................................................
........................
Integrator: FY,C4Gte
........... Operator Certification Number: ..........................................
r
..................................................................................................... .............. ............................. ........................ 11V
Latitude �� �° Longitude =• 4 =11
-Design Current.'' Design_ Cirrerit;..,"- _ . Design Curreiiit._j''
-Swine _.. Point_.._
Capacity Population r 3 £apacity _Population .: Cattle Capacity Population.: :
❑ Wean to Feeder
CK Feeder to Finish
Z Z d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number=of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area "
Holding`Poiids / Solid: Traps 0 ❑ No Liquid Waste Management System
Discharg & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ....................... ................................... ..................... ....—....... ..................................... ............................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes A No
❑ Yes ® No
❑ Yes % No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes 19 No
Structure 6
❑ Yes E9.No
3/23/99 Continued on back

Facility Number: 3f — 3f Date of Inspection
b_-Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 19 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? 10 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? '❑+Excessive Pondiyn�g j❑ PAN El Yes No
12. Crop type �� ��7 t tom! f /-� i J_A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ;SNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
X No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
29 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
9No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
R Yes
❑ No
20_
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
19 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
91 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
9 No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
V No
24_
Does facility require a follow-up visit by same agency?
❑ Yes
N No
25_
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
19 No
0: N,0-0olaticjris:or deficiencies -mere noted• during this. :vis. iC • Yoir will receive •rid. fuft. her
.. icor'respondence: abautt: this visit ... . . .. . . .. ... . . . . .......... . .... .
omments {refer to,:questio .
p
n #)- =Explain any YES answers andlor ai y recommendations oreany'ot[ er_conunents z ;
Useadrawings of facihty'Eo=ttetter ex tarn situahons:'. use,ad[Irtronal a es'as necessa }
T Mow l5jaaP7 wjllS 4o wao4� vcje- •o,4ioh4 weeds
a ✓ld b l If L lr yvr � foss Gayer- on All 21-f- l a)eeri
Iq. 'Jew I-,j4- -e
Reviewer/Inspector Name FTr �r e►rvg r� j , q .{Q ` g s �d0�'-
.,
Reviewer/Inspector Signature. Date: 5 q�
3/23/99

Facility Number: 31 —38z Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ONo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
19 No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
broken
Yes
2INo
or fan blade(s), inoperable shutters, etc.)
❑
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
IN No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
0 No
3/23/99

Division of Soil and Water Conservation 0 Other Agency
[0 Division of Water Quality
RoutineO Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other ]
Facility Number
Megistered P(Certified © Applied for Permit © Permitted
FarmName:.... .h-.................................................................
Owner Name:.5.. -.R---... ................
Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
13 Not Operational Date Last Operated:
County: ........ 11.[!��.'�.............................
........ Phone No:.. LD d-.,I,—t'�—lj F
FacilityContact:............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 1.�� ................... [c, '1� lV� � � ... t��°iQ3 t-� �\e �C `Z�3
v.................... `i. ..............
�D C
Onsite Representative:.Qk: e ..1. ... !' ....... Integrator: rator:... ....................._.......... ...`..` ! f.
Certified Operator; .................................................. .................... ................. ..... Operator Certification Number;
L U of Fa
G.... .....:..:................. ...e........ y................................... ..----`c.... ..... t !........ -..... kr` `..x J;, ............ ;
...aSLG.�....-..1s-.--. .xA��--.-�"- y
----------------
Latitude r_�• �' �" Longitude
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancetimprovement?
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?
❑ Yes 0 No
❑ Yes P(No
❑ Yes qNo
❑ Yes ONo
r
&
❑ Yes ,,�,,44 No
❑ Yes ial No
❑ Yes No
❑ Yes No
❑ Yes )d No
0 Yes KNo
7/25/97

Fadlity Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons.Holdine Ponds. Flush Pits. etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
..............................................................................
Freeboard (ft): ............ 3..,.0............
10. Is seepage observed from any of the structures?
Structure 4
❑ Yes %No
❑ Yes 0 No
Structure 5 Structure 6
............................................................................................................
❑ Yes �(No
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
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type LIZ.,..���.�...�a!'ti. f....w.��................................................................................................................
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• so.violations-or. deficiencies.were noted -during this.visk-. Yo_ u4-ill receive�itwftirilier..
correspundehce about this, visit
9Yes ❑ No
%Yes ❑ No
❑ Yes � No
❑ Yes 19 No
❑ Yes j& No
❑ Yes CKNo
❑ Yes ONo
❑ Yes 19No
❑ Yes O No
❑ Yes (0 No
1Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes allo
it" erv�jzl c�►-e� ���e�- piper
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: \�.)_C­X , 1\__It_Date: 10

�DSWC Animal Feedlot Operation Review`
�r
:A InDWQ Animal Feedlot Operation Site Inspection
s '
. ,
Routine OCornplaint O Follow-u of DN ins ection O Follow-up of DSWC review 0 Other
Facility Number
Date of Inspeciion 9
$
Time of Inspection 24 hr. (hh:mm)
Registered ® Certified © Applied for Permit 0 Permitted [3 Not Operational I Date Last Operated:
FarmName: ..... Tt,e......Eti r..r..c..........-•................................................................ County:... vtl i.)n...................................... ..W.t.. . ..
Owner Name: .... o.:..R.:..S.I.:t.Z.z-A.::AC 3r ... Phone No: {.`�.!..�l.� 2 9...6...-...l s.�
Facility Contact:
......... Title: ................................................................ Phone No:...................................................
IN -sailing Address: .... tt.L.`t........ ►A...... ............................ ....�-............. ..��.��..�
Onsite Representative:..... ..'..�......... ...1.. ?�....��.r ............................... Integrator:-.... ... �..t�.cs. .Q....
Certified Operator,................................................................................ . Operator Certification Number,.......................
Location of Farm:
tit73&
�.u► ....P—.L.L.. .......S..l.tk�� .....a .......', . j.�..l . J p. .., n .....,4 441.
@..t.......4'1 Yti �..Yw* tl..: fir. i t ......ya f.Y.: f .�y......(-
t, . -✓sac. c .tx.. K.......t�z �.................5.. ..L ..b................................... ...-------
......... ..................
Latitude • k « Longitude a 4 ;'
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
LvS
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population . Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity aaoS
Total SSLW
Number of Lagoons / Holding PondsJ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes ®'No
2. Is any discharge observed from any part of the operation? ❑ Yes 9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes 91 No
b. If discharge is observed. did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
R No
c. If discharge is observed, what is the estimated flow in gailmin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
❑ Yes
El No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
$p No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
RLNo
7/25/97 Continued on back

Facility Number: % — _3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons,11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Freeboard (ft): . 9............... .................................... ............... .................... .................................... ............... ............. ........ ....................................
10. Is seepage observed from any of the structures? ❑ Yes ® No
1. 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-I2 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste.Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... tM.,.S.4.�.�.......................................................................... .
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?
No.violations or de'ficiencies.K°ere-noted-during this.visit.- You.will receive'no further
corre:O)hdence: > out this.visit'.,'
C66iments .(refer to question Al.-. Explain any YES ansticers and/or any recommendations or
Use',drawing s of facility:to betterxexplain situations necessary):: (use additional pages as
12. e.�ai-e- bc� 5 ots o,r., ti va,.. t,.ia��- �tSo •s wov�t
�-a v..• -4 e c.O � � \-e. �-t-r tie. o f � o l °`�a a � VJ41 I. 1
7-2• 4 t t t .s e r ! af-,n �, La's
I t i o n &A-6,L '!o p )C- .
❑ Yes RNo
RYes `® No
❑ Yes 91 No
❑ Yes Ed No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 8 No
9 Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes 21 No
totr a gooJL
7/25/97
Reviewer/Inspector Name .A
Reviewer/Inspector Signature:
Date:

Facility Number. 31 - 3 "Y Z-
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: 9 2-0
Time: 3_00 , f
General Information:
Farm Name: _ .1� . Q 1, :� 4 6 County:
Owner Name: 00P• Phone No: Z9G - / zs g
On Site Representative: se. l �a Integrator: S r,;, _
Mailing Address: _IA y � NL /l v 9613 --
Physical Address/Location:
Latitude: 1 1 Longitude: I I
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No- of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer ❑ Dairy
❑ Nursery ❑ Non -Layer ❑ Beef
iZ Feeder
OtherType of Livestock Number of Animals:
Number of Lagoons: Z (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1-foot + 25 year 24 hour storm storage?: Yes ❑ No A
Is seepage observed from the lagoon?: Yes & No ❑
Is erosion observed?: Yes 19 No ❑
Is any discharge observed? - Yes ❑ No,i-<
❑ Man-made ❑ Not Man-made ++
Cover Crop
Does the facility need more acreage for spraying?: Yes ❑ Now
Does the cover crop need improvement?: Yes ❑ No4_
( list the cro s which need improvement) '
Crop type: _ ' J1i Acreage: �f a
Setback Criteria
Is a dwelling located within 200 feet of waste application? Yes ❑ No-6
Is a well located within 100 feet of waste application? Yes ❑ NodU
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream? Yes ❑ No F-
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? Yes ❑ No-d
AOI — January 17,1996

Maintenance
Does the facility maintenance need improvement? Yes ❑ No U
Is there evidence of past discharge from any part of the operation? Yes ❑ No ,@
Does record keeping need improvement? Yes ❑ No Ed
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No FA
Explain any Yes answers: Z Egg 5. Dy.j Ke-r ae;:;2 fyn N
Signature:.. 1 (� _ _ _ Date: g "ZO
cc. Facility Assessment Unit Use Attachments if Needed
Drawings or Observations:.
AOI -- January I7,I996

•
•
Site Requires Immediate Attention. �Q
Facility No. 0
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: , 1995
Time: Ze W
Farm Name/Owner:
Mailing Address:
County:
Integrator. Phone.•
On Site Representative: Phone: e6 `
Physical- Address/Location:
Type of Operation: Swine --\L- Poultry Cattle
Design Capacity: -1a ff Y Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:° �0 " Longitude: _212 Elevation: Feet
>4 Circle Yes or No '7 7 Cj
Does the Animal Waste Lagoon havSgkfficient freeboard of 1 Foot + 25 year 4 hour storm event
(approximately 1 Foot + 7 inches Yes r No Actual Freeboards Ft. Inches
Was any seepage observed from the lagoon(s)? Yes 06Was any erosion observed? Yes q9
Is adequate land available for sp ay? Yes or No Is We cover crop adequate? es or No
A
Crop(s) being utilized: ^.4 - j
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes c 1Vo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific a eage with cover/crop)? Yes or No , l l
Additional Comments: �iS l7`� � �t7 � 7 --
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.