710100_INSPECTIONS_20171231

NUH 1 H UAHULINA
Department of Environmental Qual

Type of Visit Aeompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
AFollow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: � Arrival Time: %G o Departure Time: 10 County: Wx0tFq_ Region:
Farm Name:
Owner Name:
Mailing Address:
Pbysical Address:
Facility Contact: (� Title:
OnsiteRepresentative: �.>UDPLI,,'� rWa
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 6 0 6 = « Longitude: = 0 0 & = «
Design Current
Swine Capacity Population
Design Current Design C►urrent
Wet Poultry Capacity Population C*attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer 1
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Non -Layers
❑ Pullets
❑Beef Feeder
❑ Beef Brood CovA
❑ Gilts
❑ Boars
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
El NA
[I NE
other than from a discharge?
`
12128104
Continued

Facility Number:-T Date of Inspection
Waste Collection & Treatment
"Ayes;
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
"Ayes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ( _,qGOCW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes *o
❑ 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 [I NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA X NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
❑ No
❑ NA
% NE
❑ No
❑ NA Z NE
❑ No
❑ NA
,o NE
❑ No
❑ NA
NNE
Comments (fefer to question 01 Explain any YES answers and/or any recommendations ar any other' com ents.
Use drawings of facility to better erplamsitnations: (nsesadditio>tal pages as necessary,):
mEss*e -,14A_� HE wAs r� H�Q� N s CA'Paa-v
1.V auCr�� t_FV_ 4
Yf,06 WIC-L- CO1VTfACt 1CW1 16RV4Ci46 �U 6E 3UDA PdT�s �-�,v
Reviewer/Inspector Name S Phone: f/ 6 ` 6-
Reviewer/Inspector Signature: Date: j
12128104 Continued

Facility Number: j -gyp p Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA NE
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA / NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes N No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes] No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional-Camments.andlor Draw".,ins }` s ;
'byTC�-) wD7EXL) S C-I EA9- - IVO UIS IgLC S'jGAl 0li:: 1+26 tWAS J�
12128104

Type of Visit gkCornpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine kComplaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Y1 Arrival Time: © Departure Time: ] County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: / Title: Phone No:
�
Onsite Representative: _ Vl 1 ' I N a Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [� c [� I [� gf Longitude: [� ° F-1 & [� 46
esign Current
Swine Capacity Population
Design C►urgent
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[-IBoars❑
Dry Poultry
❑ Layers
Non -Layers
❑ Pullets
El
❑ Turke s
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
Beef Brood Cowl
Other
❑ Other
10 Turkev Poults
❑ Other
Number of Structures:
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure % Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Yes ❑ No ❑ NA ❑ NE
❑ Yes
IM No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
El NA
❑NE
❑Yes
No
❑ Yes
1ANo
❑ NA
❑ NE
❑ Yes
TANo
❑ NA
❑ NE
122/28/04 Continued

*Facility Number: — 1a�
Date of Inspection 1U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
,ONE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
gNE
(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 [$i NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 1
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NANE
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. - "AYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift XApplication Outside of Area
12. Crop type(s)
13. Soil type(s)
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
WNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NNE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA )� NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
XNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DkNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers an&or any recommendations or any�otheQomments,�
Use drawings of�facility to�:better.explain"situations. (use additional pagesias
Fisr C�1 OIN� A CCi-nP A�:t FflRLm s0Z14L
.)9IJVT
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NOT! G 1 E� �O �
W4457C.
�(71 o Cl�S �F [ Z.�I/JG 2E 11�C� QN SiU�ln)� THE:
Reviewer/Inspector Name I 4 6 A IN Phone:
Reviewer/Inspector Signature: Date: Lis 1 lc�
12128104 Continued

Facility Number: — Date of Inspection i U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
❑ Yes ❑ No ❑ NA �NE
❑ Yes ❑ No ❑ NA aNE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
VNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
XNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
N 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
b(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
XYes
❑ No
❑ NA
❑ NE
AdtlrtionalCoatments�a�dLor�.Drawings:,
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v 12128104

Type of Visit
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
ReasonforVisit
7RoutineO Complaint
0 Follow up O Referral ()Emergency
0 Other ❑ Denied Access
Date of Visit: I $ 4 0Arrival Time: 9; 30 Departure Time: County: E�(!�}� - - Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: fAAXG KWA
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = i = Longitude: 0 ° = 1 0 «
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La et
❑ Dairy Calf
® Feeder to Finish
140
�' j"' j�� �� �f
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultr�
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
El Other
Number ofStructures:'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R(No
❑ NA
❑ NE
other than from a discharge?
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? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 Cj, '%
Observed Freeboard (in): Lt
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
�N El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
;No
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ 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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
7No❑ 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 ElYes
/
2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift El Application Outside of Area
}❑
12. Crop type(s) CUY5 C41TW-
13. Soil type(s) Lis
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
QNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[f10
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
E? o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 Nc ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
p.N 4 Zt Cn a ps to 01 ci G noD .
Reviewer/InspectorName xry Phone: � to 6
Reviewer/Inspector Signature: Date: grr i
12128104 Continued

Facility Number: 71 — I b O Date of Inspection GI o5"
Required Records_ & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �/No ❑ NA ❑ NE
the appropirate box. ❑ A;'ff Tp ❑ Ch kl' t ❑ D s' ❑ Ma s ❑ Oth
ec .. e gn p er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ 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?
El Yes
❑ NA
Elo NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
E3 N/No
,�,
El NA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
ElNo
[2 NNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
Lif NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
j!JlNNo
❑ 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
9,mo
❑ 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
��
U/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
E 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
1d N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
12128104

IType of Visit 0 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number pp Date of Visit:
f
Permitted OrCrtMed E3 Conditionally Certified 13 Registered
Farm Name:
Owner Name: _ .,�iC� _._. .
/ Q Tune: �
NNot erational 0 Below Threshold
Date Last Opera Above Threshold:
County:
Phone No:
Mailing Address:
Facility Contact: ..__ /�, _ --..Title: ��_� �Phone No:
Onsite Representative: cool (, 6��! T Integrator.
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle © Horse Latitude 1 •�• t 49 Longitude • 1
Cnrreri
Design q t>
tht
CumCtarren
Swine Po tioa `Poultry, c ;PoT t<an Cattle
Po 'on
Wean to Feeder - Layer
- Dairy
Feeder to Finish = Non -Layer
Non -Dairy
Farrow to Wean '
Farrow to Feeder
Farrow to Finish
r
TOta1 D �$� i ;.
.
is
s� - - Tfltal SM Boars
�7d
Discimmes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 91 No
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ 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 ZNo
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 ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier_
Freeboard (inches):
12112103 Continued

Facilitv, Number: I —/p p I Date of Inspection 1 2 O
5. Are there any immediate threats to the integrity of any of the strictures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes WrNo
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 JZ No
8. Does any part of the waste management system other than waste structures require maintenancel-improvement? ❑ Yes RrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes XNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type eFNo 5 cc) a'r) , C 0-r�o to , � MPS O-Pfr�
�--•— �• � j$No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAViWMP). ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 'Oo No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes PrNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JZ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1ONo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
Fs„nsN 1PVk)e^jr
GqC'Oo�
22 rgpPLze����
Reviewer/inspector Name
Reviewergnsspector Signature:
Date:
12J11103
Contnurd

FaciliV Number: 00 Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
)eyes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ 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
W(No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
;( No
27. Did Reviewer/inspector fail to discuss reviewtmspection with on -site representative?
❑ Yes
;g No
28. Does facility require a follow-up visit by same agency?
❑ Yes
EXNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ZNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35)
❑ Yes
oNo
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 Foam ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
14 X71 �ECvRDs S cJ[✓� �
(iflL7 F—�Fp I�,e 2v c3 0 �4„� 4-C s, _�� rc f� 70 r-
��Qfrr Lw,�ek
12/12/03

(Type of Visit (a —Compliance Inspection 0 Operation Review Q Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Fallow up O Emergency Notification er ❑ Denied Access
Facility Number Date of Visit: Time: �
10 Not Operational 0 Below Threshold
Q Permitted © Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: U 1 h CC-e,�nG _ y��. q _ County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
$wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �o �
sign " Current- = <„ Design Current Design Current
Swme Ca aeity P,o ulanon Pl-ultry Ga aci P,o ulation Cattle Ca acrty Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish 10 Non -Layer I I 1EINon-Dairyl-_�_
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present_❑ La oon Area 10 Spray Field Area
Holding Ponds / So[id TrapsIF-----]=IEI No Liquid Waste Management S stem
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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Was Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101 ht5
❑ Yes 0-No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes D~N-0'_
❑ Yes DNT'
f ❑ Yes ❑ No
% Structure 6
Continued

c
f
Facility Number: 1 — /(3Date of Inspection 1 7- i 9 7571
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A,unlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
es ❑ No
❑ Yes ❑ No
❑ Yes [--]No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ments(refer to questioin #): Explaui,anyYE$-: na savers and r any recommendahansforeny other comments"#
RUNOPMI
facihiy to better-eiplaeu„situahous "(use.addjtionahpages as necess❑Field
._ 9Vng�&,g�o�f Copy ❑Final Notes
''^7i-:,: jY 1c? i .a
'$d:1s�..:�^%S"a".;aa
Rnjl_�C3 WMJ'
J
t Q " CX-o $o�
hod kvu7-L, ,_O— d r1D4- wctikA- ,
Reviewer/Inspector Name"-
Reviewer/Inspector Signature: Date: —
05103101
Continued

s 1`
Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other
Facility NumberEIRD—E=
Date of Visit:
Permitted 0 Certified [] Conditionally Certified © Registered
Farm Name: __ K� l .—. _
Owner Name: [-- RA�2 \ `�
Mailing Address:
Time: t�
❑ Denied Access
Date Last Operated o bove Threshold:
County: /F--V o
Phone No:
Facility Contact: // _1} Title: Phone No: _/.
Onsite Representative: � 0 7__ �IvG Integrator: / ` 11A��15�'
Certified Operator: Operator Certification Number:
Location of Farm:
Swine []Poultry []Cattle ❑ liorseLatitude 0 � �" Longitude o 6
Wean to Feeder
Feeder to Finish
LJ La er
„A ❑ Non -La er
I❑
lJ D
N
Farrow to Wean
❑ Other
Farrow to Feeder
Gilts
Boars
Subsurface Drains Present illJ Lagoon A
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): �©
05103101
❑ Yes I(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes 11
No
❑ Yes �No
Structure 6
Continued

Facility Number: Date of Inspection L-T/�YJ/UQ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pond' ❑ PAN ❑ Hydraulic Overload
12. Crop type So r O Ton)
p
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?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(icl discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes [jNo
❑ Yes , ,�(No
❑ Yes No
❑ Yes V(No
❑ Yes VNo
❑ Yes l/I No
❑ Yes A, No
El yes / No
El Yes No
❑ Yes ❑ No
❑ Yes oil' go
❑ Yes XNo
❑ Yes FfNo
❑ Yes XNo
❑ Yes XNo
❑ Yes XNo
❑ Yes VNo
❑ Yes No
❑ YesNo
ElYes /No
❑ Yes //////] No
13 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
v S(aL. 'r fie_. 7�, "'. 's°:.^c- &'. i-i - '':,".
Comments refer to.question #) lExplaer[ any YE5 answers and/or a©y recommends moans ar any other comments ,y
Use diavnngs of facility tubetter expgatn srtua4ons y(ueadditeonaLpages asn ry)� - Field Copy ❑Final Notes
writ.:
Reviewer/Inspector Name
Reviewer/Inspector Signature: 7 X.74T, 7 Date: Z
—• — r v f
0510310I Continued

Facility N,mber: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permancndtemporary cover?
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes (( No
❑ Yes ONo
❑ Yes I� No
❑ Yes ?E]'No
o
❑ Yes
Additional Conimen is and/or rarving
i
7
O5103107

Division of Water ah ty a
:
Q Division of Soil -and Water Conservation
QOthe
r Agency...
of Visit -9(Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit ), Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 6 Date of Visit: Time: a co I Printed on: 7/21/2000
Q Not O erational Below Tbreshold
V(Pernutted ❑ Certified [3 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name [ County: ......................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
Facility Contact:.............................................................................. Title Phone No
MailingAddress:.................................................."............................................................................... ..........................
Onsite Representative: ..�Y
........................
Certified Operator:
Location "of Farm:
Integrator:..,. .
Operator Certification Number:. „•.
[3 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �' �"
Dcsiign Current Design Current Desngn Current
..; :..-. Ca . d -Po ulation Poultry Ca pa Po ulation Cattle... _.. Ca ,..Po Atiou
Wean to Feeder ❑ Layer ❑ Dairy
- Feeder to Finish U d ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Toti gn Capacity
Gilts
Boars Total %.Lw
,F
} Subsurface Drains Present ❑ Lagoon Area
Naimber"fif Lagoons ❑ ❑Spray Field Area
Ponds / Solid T Holding raps:' _.- ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El 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 O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes V(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;4 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...........
...................... ............. ....................................
Freeboard (inches):
5100 Continued on back

s
Facility Number: — cQ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �<No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes XNNY,
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes O No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes qNo
11. Is there evidence of over application? �l ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes XNo -
12. Crop type C Awl$ GC.Tfe`'\
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N(No
b) Does the facility need a wettabie acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? IKYes ❑ No.
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N j ioijt i4ris :e- iiffl ckncie wire no e(7 dtirritag ibis:visit; • Y00 wiii-teo iW 40 fu"hgr
;corresfideitce: aVoik this visit: • : -
❑ Yes b'No
❑ Yes WNo
❑ Yes gNo
❑ Yes P(No
❑ Yes eNo
❑ Yes P No
❑ Yes VNo
❑ Yes )dNo
❑ Yes No
❑ Yes No
❑ Yes. VNo
(Lo
w t`�
a :ram v�.-_xr,.f-, , .z.�y �.zx•", -.0 �, ty;, f ': zn-.-�'�'xi.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: PEA 8'tq 5100

Facility Number: — Date of Iuspcction {Tinted on: 7/21/2000
Odor ISSUES
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N(No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[� NO
roads, building structure, and/or public property)
�1
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�?No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
kNo
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
KNo
Additional.Comments an orDrawings:. .
c
4z�—
�
g
tt
C
5100

•
m T Drv�sion of Water i�ualhty
r
.Q i)rvrsion;of Soil anil:Water Conservation.
Other AgenFy
Type of Visit %gCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date: of Visit: Z (o �� "rime: s= Printed on: 10/26/2000
� t 0 b
Q Not Operational Q Below Threshold
S'Permitted [3 Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold : .........................
Farm Name: i he C i3-r C ► d ... County: �E'.'►Gtf e .....................
....................................r .... ................................................---•---.................' --...
Owner Name: ...................�:e.t'4�'.....C........ ..................
/C
I . ......�........................
FacilityContact: .............................................................................. Title...........................
MailingAddress:...................................................................................
Onsite Representative:..... I K
Certified Operator:.......
Location of Farm:
Phone No:.... ...............................
Phone No:
Integrator: , M,qr �
Operator Certification Number: ................
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 Longitude • 6 44
Design Current Design Current Design Current
Swine Capacity Population poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer 1 1 ❑ Dairy
P�LFeeder to Finish :ZRg JEI Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 1. 10 Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ID No Liquid Waste Management System
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes JdNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. It' discharge is observed, was the conveyance man-made? ❑ Yes XNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes KNo
c. If discharge is observed. what is the estimated flow in gal/min'? h t9
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) []Yes U No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JdNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...... ............................. ............ ........................ ........... ...-................ ..... .... ................................
Freeboard (inches): t
5100 Continued on back

Facility Number: - J BD Date of Inspection Printed on: 10/26/2000
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[] Yes
9No
seepage, etc.)
6. Are there 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
K No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
NeYes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
KNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding [IPAN❑ Hydraulic Overload
El Yes
® No
J
12. Crop type C ar ry � n e 7 .Se LeA yr S rs�► r 11 G ✓ F t
13. Do the receiving crops differ with those designateA in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
0 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
IN No
16. Is there a lack of adequate waste application equipment?
❑ Yes
2g No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes Z No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 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 ,g] No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes EfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
N,6.. iglati6iis:or deficiencies v�ere i�gfed ditrih 4his;visit: - Yoit Will -receive iid fu ther • . • _ -
corres oritieince: about: this :visit.: • � � � � � � � � � � � � � � � � � � � . . . . . • ' '
Comments "(refer to question #): Explain any YES answers and/or any recommendation-s:or any other comments. -•
Use:drawings of facilityto better explain situations. (use additional pages as necessary.): - --
f�• IreGarat.-A1eed Za00 so;1 �
Ned -� ?e1pA�cer_�0G'-dyeCdt'-'� Pi'Q'14
4 '14%dr bl-c AJ;a moor e6, A116 IJA PItc /110; L.Jasfc
Use c-✓a sir✓ q+�aj;s o4GJ-{�Sys �,�' olpp I� c�tfro�• oh z�n-2's
Y!ecGi fo Ste ..fVv'+/rcr IoffGj� 1 /' i � ��a'L. t GOYGtr. Have 19,16) Wel4e
s i _JA$i IR`i�i Presar?k4'ree boc ,ed r2rOv-15,-} f 19c° sv,t.r� e-r&6�4�
Reviewer/Inspector Name . 57e ln e w q IJ &7 .4 4 kjr
Reviewer/Inspector Signature: Date: )Z 4 B 8 5100

Facility Number: Date of Inspection pb Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes JffNo
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 IgNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? $ryes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes A No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JR'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Z No
Additionall'Comments andfor'Drawings:
1q • a,}��]�cG-��a�-, re�ar�.s av�f]a��� �,� �21))�40
5100

r'
Facility Number 1 bjJ Date of Inspection
Time of Inspection E : DO 24 hr. (hh:mm)
Permitted#Certified © Conditionally Certified j] Registered 113 Not O erational Date Last Operated:
Farm Name County:...........1U�C......................... ..... 0.
�9 `II
Owner Name: �' „ h� �I O 2 f . Z 0 z
---- -.......................�.�......... ...-----------.....................-................................. Phone No..............-.................................................................
FacilityContact: ............................................. ................................ Title: .................................`...j...................r........... Phone No: ....... ..-.........................................
Al
Mailing Address: Z{�(� G.✓ I`."-.{.....I4j:n... �`S.1 . ....... .....1..P G�1..Q. .... /C........................... ..........................
Onsite Representative:......,! .�.C%L.d � ... Integrator: a j� ........................
............................................... ....... v!......
17
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
i
L:..- ................................................ -1.1-1.1 ............. I .......................... ..... . . . . . ................................................................................................................................................................................................................................................................................. �
Latitude �•�� �•� Longitude =• =' ="
• Design Current Desin ; Current Design- - Current
:, .
Swine - Capacity Population .'Poultry ��Ca achy Population Cattl'e� Capacity Population:
❑ Wean. to Feeder
Feeder to Finish
Z 4Q0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
EE
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dais
❑ Other
Total Design Capacity
dtal
-,
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area][]Spray Field Area
Hvldmg Ponds /Solid Traps❑ No Liquid Waste Management System f
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 S€ructurc 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): z.......... ..... .................. -- ......... ... ............................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )No
❑ Yes W0
❑ Yes KNo
Structure 6
...............................
Cl Yes )} No
Continued on back

Facility Number: — o 6 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenatice/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 ffPonding ❑ PAN
12. Crop type r , 1, Rk L'.J kej & I /
13. Do the receiving crops differ with those designated irf 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?
yiolaiioris ;or def ciencies mere noted• d&ihd �his:visit' • ;Y:oit will •reaei . e Rio fufr her
.correspondence. a�ouk this visit. . . .. . . . .. . . . . .
❑ Yes�jNo
❑ Yes t�&o
❑ Yes Wo
❑ Yes �No
❑ Yes MNo
❑ IV114NO
❑ Yes �Io
❑ Yeslo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ANo
❑ Yes )R�o
❑ Yes ` ;Mo
❑ Yes Wo
❑ Yes Wo
❑ Yes ) No
❑ Yes R No
❑ Yes `P�K)
❑ Yes 3RAo
❑ Yes No
[]Yes No
Commenis`(efer to question #) Explain any°YES answers and/or aiiyrecommenciations o%any other comutents W _-
- -.
Use,drawtngs.of faci ity to Better explain situatious (-us e.additional,pages,as necessary}
' �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: f L `7 -
3/23/99

Facility Number: — ate% I)ute of lizspection 17,
r 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 YNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesTo
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 KNo
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
3/23/99

Revised Aar 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - 1.06 Operation is flagged for a wettable
Farm Name: U- +ti acre determination due to failure of
On -Site Representative: /Part 11 eligibility item(s) F1 F2 F3 F.4
Inspector/Reviewer's Name: dperation not required to secure VGA
Date of site visit:_ - 11 z�
Date of most recent WUP:
Annual farm PAN deficit: _a WZ. pounds
y -
determination at this t►me based on
exemption ,�D E2 ' E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation Systerri(s).- circle-#: . hard boseir2veler ..center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; a. stationary sprinkler system wlportable pipe;.
6. stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART i. VVA Determination Exemptions (Eligibility failure, Part 11, overrides Part 1 exemption.)
_ Ie EI Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and WD3- irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE_
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOT E:75 % exemption cannot be
appiied to farms that fait the eligibility checklist in Part It. Complete eligibility
checklist, .Park 11- F1 F2 F3, before completing computational. table in Part Ill).
PART 11.75% Rule Eligibility _Checkiist.and_Documentation-of WA Determination
Requirements. _ WA Determination required because operation tails one of the .eligibility
requir rments -listeddaelow:
_ F1 Lack�oi:acr--age+which-resuiteddn:overzapplicafio=fwas-tewaier=(PAN) ❑n:spray_
Tield(s)mccordingioiarm'adast:twoWears �ir--irrigauan-zecotls-=
F2 Unclearjllegible,or lack -of inmrmationfmap:*.
_F3 Obvioussieldlimi ations-(numerous�itches,=--�aiiureio:ded�ctTequired-� .- .
bufferlsetback:acraage;-mr2b°a-oTfotaimcreage-identinetidri�AWNIP=includes= -: =
small;_irregulariy:shaped-ields _Fields:less--ihan:5�bcresdor-.tavelersmrJess-ih2n -_=
2 acreslorztationaryzprinklers)-
F4 WA determination -required because CAWMP= creaitsJield(s)'s acreage in -excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, 1999
Facility Number -
Part Ill. Field by Field Determination of 75% Exemption Role for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBEW'2 IRRIGATION ACRES ACRES %
SYSTEM
-I
I I I
I I I I
# I I
I I # I I
I I I # I I I
FIELD.NilNiHEr ' - hydrarn,-puii,zone; -or:point numbers -may be used in glace -or neld numbers bepending on GAWMP
and type of inication-systarm- It pulls, tetc: cress -more-than one held, inSDemou'reviewer will have t0 combineiieids to
calculate 75% held by held determination-for�xemption;-otherwise operauan Will be subject to WA determination.
F3E� D NUM3E�z - must De.-ciearly delineated an -map.
COMMENTS' --back-up fields with CAWN[P-acm..-75% _75% of ts-total_acres-and-havingreceived less fhan 50% '+
of its annual .PAN -astocurn--rgid in fneTaran's�previous:iwo_years' {Zg97 &.199B}jaf:inigaiion-iecords, cannot-serve-zs-the
sole:basis- ,--i--quiring-aWADes,.erminaiion:�:Back-uptelds- nustbemoied infnR : arsiment:secbon:and-Tnu sttsa accessible
by irrigation zmeth.
Part IV. Pending WA -Determinations
P1 Plan Jacks following information:
P2 Plan -revision-mayzatisfy`7.5%-rule-b2sed .on adequate-overall.PAN derlcitandby
adjusting all fieldacreagafobe1ow75% use --rate -
P3 Other (ielin process of installing new irr gation system):.

r
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10,Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
[] Registered © Certified ©C�Applied for Permit Permitted
FarmName: ....................... .......L.---....................I.............................................
C-�;
Owner Name: "
Date of inspection 1f1_
Time of Inspection 1 16! I 24 hr. (hhmun)
Not Operational DateLastOperated: ... .......................
County:
.........q................1.
.-.1 . .......................
Phone No: `�Q 2 C 7 Z
Facility Contact: .................................................................. . Title: ... Phone No:
Mailing Address: ....... .1. Z. G............ ...... ..'�"ry ............. f ....-•.-----...---• =
Onsite Representative:........... k W.4.y......... ........................................... Integrator:.................`L ' ��..... �...'.!.'."`..............I.........
....
Certified•Operator: G""'`-<.'...................................... Operator Certification Number:..."............................ -
Location of Farm:
Latitude •' 66 Longitude • ` "
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes o
2. Is any discharge observed from any part of the operation? ❑ Yes to
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes o
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 ATOPRo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ❑ No
5. Does any part of the waste management system (other than lagoons holding ponds) require ❑ Yes ❑ No
maintenance/improvement?
b- Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
7/25/97
0
'o

Fagility Number:
r' 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑ No
Structures (LagoonsAolding_Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):.................................... .................................... ............................... .........................................................
10.
Is seepage observed from any of the structures?
❑ Yes
❑ No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
❑ No
12.
Do any of the structures need maintenancelimprovement?
❑ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type.....................................................•...............................----.--.----.......---.---..........................---.......----------....----..........................................------..........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
❑ No
18.
Does the receiving crop need improvement?
❑ Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
❑ No
22. Does record keeping need improvement? ❑ Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes )R�No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 'dNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes E No
No.vio'lations' - deficiencies. were, noted,during this:visi& You:mill i eciro:ftirilier
ebrrespondeilco ti out this:visit:: :
;> + +.5Pc4 s�7 VI 4.�; 4�s wc..e_ PP-GS
7/25/97