430030_INSPECTIONS_20171231

i t
19 Division of Water Quality
Facility Number �--� O Division of Soil and Water Conservation �� S
- Q Other Agency �
Type of Visit V 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: Departure Time: ® Counk.
i
Farm Name: Owner Email:
Owner Name: - Phone:
Mailing Address:
Physical Address:
Facility Contact: � •► 1 \ j-r\MOn5 Title: _. 1`�l Phone Nod LO 2 8
Onsite Representative: ' r I I k_R _ ansmDVIS Integrator:
Certified Operator: {JG Operator Certification Num l
Back-up Operator: Z_ i m r mem Back-up Certification Number:
Location of Farm: Latitude: = ° ` " Longitude:
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder JO Non -Layer
ceder to Finish I Iq Zo 11f 1z
[:]Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
I I-
0 Dairy Ficifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 711
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 V No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
❑ No
J, NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
Epo
❑ NA
❑ NE
12/28/04
Continued
140

Facility Number — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA
[INE
a. If yes, is waste level into the structural freeboard?
❑ Yes
JZ] No
❑ NA
❑ NE
Stru ture 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9,Vo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
UNo
❑ 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
'§LNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
V No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ yes
�K No
❑ 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 > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind D
rift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in thL�-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
No
No
No
No
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):
- U%Z- fw� c_�\wkzd e§W'N"
❑ NA ❑ NE
❑ NA ❑ NE
[1 NA [3 NE
❑ NA ❑ NE
El NA 0 N
Reviewer/Inspector Name J f / N ' Phone: J
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility
Number:q3 b:?/7) Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tf No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ 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 ID No�NA El 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
P NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4No
❑ 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
XNo
❑ 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
%I No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28104

Facility No. f'--� Time In ��J Time Out
Farm Name Integrator
Owner /W�.. Site Rep
Operator — -TNo. Z) J I�
Back-ups No.
COC Circle: Gener or NPDES
C
'�
Dat ��
Design
urrent Design Current
Wean – Feed
Farrow – Feed
Wean – F' ish
Farrow – Finish
ed – Finis
Gilts 1 Boars
arrow – can
Others
FREEBOARD: Design
Z 12
Observed
Crop Yield
Rain Gauge
Soil Test " it 1 O'L Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop -� O
Weather Codes 0 min Inspections
Waste Analysis:
Date Nitrogen (N)
li Z o-7 �L
Sludge Survey V A)d
Calibration/GPM I
Waste Transfers —~
Rain Breaker �
PLAT
1 -in Inspections
Q0,/ J.'k c_r ,
Date Nitrogen (N)
D 3
Pull/Field Soil Crop Pan Window
i

Division of Water Quality 11
D,Division of Soil and Water Conservation Ili
Facility,Number
QOther Agency
r61
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 [:1Denied Access
Date of Visit:
Farm Name:
Owner Na
Mailing Address:
Physical Address:
rrival Time: Departure Time: County: liar% RegionEj
t4,p,(•� Owner Email:
i\m 1(C r0.a rU QSL� Q Phone:
Facility Contact: -.1C�-l—lf-�ru'3 lt)_tod ngn Title:
Onsite Representative � p_ h' L]( 3��_
Certified Operato
Back-up Operator: rniYi"
Location of Farm:
Phone No:
Integrator:
V
Operator Certification Number.0 v —1
1 S
Back-up Certification Number: a,51 I I
Latitude: [� o [ [� Longitude: =0=1 o=1
Design Current, Design Current . P Design. Curre
Swine ;" Capacity Population: Wet Poultry Capacity Population Cattle Capacity . Populat
Wean to Finish _ ❑ La er
Wean to Feeder ❑ Non-Laye
Feeder to Finish '79
Farrow to Wean I Dry Poultry
Farrow to Feeder
Farrow to Finish ❑ Layers
Gilts ❑ Non -Layers
❑ Pullets
❑ 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?
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow,
Number of Structures:.,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes *o ❑ NA ❑ NE
Yes E01 No NA
❑ NE
❑ Yes ❑ No A
E❑
❑ NE
❑ Yes ❑ No _;jJTfA
❑ NE
❑ Yes ® No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
12/28104 Continued

i
Facility Number: Date of Inspection #4D�_
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?
rpcture 1
Identifier; Stj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes N No ❑ NA ❑ NE
❑ Yes ❑ No [SNA ❑ NE
Structure 5 Structure 6
❑ Yes TiNo ❑ NA ❑ NE
❑ Yes--15Vo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes *o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �o El 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 El Yes JONo ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 41itNo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes XNo
❑ 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 [IApplication Outside of Area
12.
Crop type(s) .Lx•1 i'1i(.� f�iQ ' 1f7 C-1, d
13.
- r
Soil type(s) G / /ea -d
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,@,'?4o
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes rgNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes IR- No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes'&rNo
[:1NA ElNE
18.
Is there a lack of properly operating waste application equipment?
ElYesNCVko
❑ 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 I k,� W ST n LA =K Phone: kO _2
Reviewer/Inspector Signature: Dat : " W
Page 2 of 3 12/28/04 Continued

Facility Dumber:j� 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 ❑ 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
❑ Yes
$] No
❑ NA
❑ NE
❑ Yes
t No
❑ NA
❑ NE
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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
' No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
�'] No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
$'No
❑ NA
❑ NE
❑ Yes
$d No
❑ NA
❑ NE
❑ Yes
rQNo
[INA
❑NE
❑ Yes
W No
❑ NA
❑ N E
❑ Yes
P No
[]NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
tE No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Prm skr1
t? lL;tUzV,_.
T44
Ul:x mos -i' Cir en4 C¢l ; 6( o. -j 4-
1a.`i r,ri
if q b b.
c
r%4 C°. wusR,
Page 3 of 12/28/04

• i
Facility No. "[ C Time In Time Out Date f'
Farm Name Integrator
Owner Vi Pup, �� U�g0,V"7, CL V- ( n C__ Site Rep S Ilr`d0u U_111�
Operator
No.
Back-up I No. _
COC LI/— Circle: General or PDE
Design Current
Design Current
Wean – Feed
Farrow – Feed
We b
Farrow – Finish
eed – ugii==2 –79 ZQ
Gilts 1 Boars
arrow – Wean
Others
FREEBOARD;
Sludge Survey
Crop Yield _
Design a I = 31 •���
Rain Gauge/\(}/{���
\ .
100
Soil Test w Z1 VL PLAT
Observed
Calibration/GPM L,�1
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard �` Daily Rainfall ___1 1 -in Inspections L__
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis: '7
Date Nitrogen (N) Date Nitrogen (N) ,v
I fa3 �t, to cv (P i0l
113 2 `•k. 11� 1010 3
01k, 3-o Sf1�
EFMU7 • i
im! MINOR
1AIRWIMMMM410, ORA W4 MWOM ""I
0

Type of Visit 0
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
pikoutine 0 Complaint
0 Follow up 0 referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 11-13-(24,1 Arrival Time: Departure Time: rr County:/i1�' "fi' Region: 11`�H,
Farm Name: Z rt,rrxLn i sH_ raeYY,--. . Owner Email: ---__-..--
Owner Name: s��( %r^m 4,,,.D_ 1Phone: j
Mailing Address: /. D 13 t7 i� 3��9 ___ _ �� % �"�' � L
Physical Address: �7
Facility Contact: ,/I�JL/l. ,LZue ! Cr L,4=&,L Title: Phone
Onsite Representative: Integrator:
Certified Operator: �%brl te tLrj1'✓" Operator Certification Number: "771r__
Back-up Operator:
Location of Farm:
ISwine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ZI
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 ofthe State
other than from a discharge'?
❑ Yes RNo ❑ NA EINE
❑ Yes
51No
❑ NA
❑ NE
❑ Yes
[gNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
� No
❑ Yes
R No
[INA
❑ NE
❑ Yes
ANo
[DNA
❑ NE
12/28/04 Continued

.. N
Facility Number: — Date of Inspection r 1:2R.
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 5U No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
LN No
Structure 6
Identifier: I
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C9 No
Spillway?: 4-54
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',',[:]
Yes
Designed Freeboard (in): Ft
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Observed Freeboard (in):�
Cj� No
❑ NA
❑ NE
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
0 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
C,No
[INA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes MNo ElNA ElNE
(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 [RNo ❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
I. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®,No [INA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LN No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',',[:]
Yes
I& No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Cj� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
h y/� 7aReviewer/Inspector Name� VPhone:
Reviewer/Inspector Signature: Date: /—J '3 —ePOV o
12/28/04 Continued

Facility Number: -- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropirate box. El WUP ❑ Checklists
❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fA 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
UR.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�Z 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
[allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
X,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
PNo
❑ 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
Jallo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ YesPhi.No
[:1NA
❑ NE
Additional Cominentsia"ndlor`.Drawln s c NMWI
g.sir."io"='������'�arF W"Z 04
12/28/04

A
Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 7J 3 e O Time: : 0 b
Facilin, Number 3 4
Not Oerational Below Threshold
® Permitted ® Certified M Conditional)}- Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: 13 L, r -PL r� _ kt 6L --t F6„Ln _ __ ___ _ County: a _, _
Owner Name- Prem u m Phone No: A t 0 4ti.2.
Mailing Address: _-A-6-1 RN)e
Facility Contact: „r�1+ ��,r.l��e C r, sf � Title: Phone No:
Onsite Representative: !2t t ckeAe_. f;.l-,r 1 S'� eJt� en. - lntecrator: PS
Certified Operator:E �r PI -1.i, f""'CT Operator Certification Number: ;k'�� I j
Location of Farm: d`
X Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' Di 0" Longitude 0' `
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder I ❑ Laver I Dai
® Feeder to Finish d ❑ Non -Laver I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I f _ i ILJ Subsurface Drains Present IILJ Lagoon Area JU Spray Field Ares
Holding Ponds / Solid Traps j ❑ No Liquid Waste Management System
Discharaes 8 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 obsen•ed, 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 8 Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches): �33
05/03/01
❑ Yes n No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
m No
❑ Yes
[9 No
❑ Yes
151 No
Structure 6
Continued

Facility Numhcr: — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes (� No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes] No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
eievation markings? ❑ Ycs ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes CS No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes (S No
12. Crop type 13 Pr nr, U 01-1 "_ -l— ..0 V" . 6,
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? ❑ N'es ❑ 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
0 No
Rgguired
Records & Documents
Reviewer/Inspector Name �` . 4
Reviewer/Inspector Signature: Date: 0
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P 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
13 No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
CS 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 Reviewed]nspector 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
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
lain'ati YES answers and/or an recommendations?nr,an of
Comments (refer to;questlon #}. Ex' p y y y ' her comments.
Use drawings of facllity to b'etter'explain situations. (use additional pages as. necessary) ' r�
V. ❑Field COPY El Final Notes r
�s
d' mifo rc -"r
Reviewer/Inspector Name �` . 4
Reviewer/Inspector Signature: Date: 0
05/03/01 Continued

Facility Number: 49 -3 D Date of Inspection
QAU Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes P No
❑ Yes ®No
❑ Yes &No
❑ Yes ® No
❑ Yes IM No
❑ Yes ❑ No
,Additlonal Cbtninents and/or-DrawltiQs. j ' "
I, •� F. Y i .:.:.�. ar i. �. �.��1...'i�{yok}� �� .�u-t�i`�I�1;]ii.
05/03/01
05/03/01

13 Division of Soil and Water Conservation - Operation Review r
0 Division of Soil and Water Conservation - Compliance Inspection
} Division of Water Quality =Compliance Inspection rx
[Other Agency - Operation Review
10 /routine 0 Complaint Q Follow-up of DWQ inspection Q Follow -ice of DS1VC review_ Q Other 1
Facility Number - I):rte of Inspeclion
'Time of Inspection E=24 hr. (hh:mm)
j Permitted © Certified © Conditionally Certified E3 Registered R3 Not Operational Date Last Operated:
.Farm...........-.............�..�......'
Name: �............................................. County:......... ...... .........,.... . .............. ..........
Owner Name:. .... ......I�.J.. t. C1 .. Phone No: 5�
t..1... / . !'s. .....................................
Facility Contact: ...... !i qj �ic //�C .. Title: .. ....................... Phone No:...................................................
Mailing Address:..... Q�.. !.:.�,U!(II.C..... .C....... ! c............................................d..l. .14:� ,r'S..L.f.... .C.. 2—'x.37.....7..!
/� I
Onsite Representative: rG .... a~ r-2'nzlC.�'...P.-'l iti Integrator:.........(....a.t k`.4..�1..�5......................................
Certifiers Operator:.... ,� t �.............................. d4...... i;?.1r.U4..... Operator Certification Number:..........................................
Location of Farm:
..................................................................................................................................................................................................................................................................... 41 i
.............. ............... ................ ................................ ..................................... .......................... ............................ ................................... ... ...................... ......................................
I T
Latitude •�4 " Longitude u• 69
Design Current
TNo
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish -7q-2-T
❑ Non -Layer
JCI Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
JEJ Other
❑ Farrow to Finish
Total Design Capacity
-7172-0
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑Subsurface Drains Present, ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
DischaEg!js & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance yuan -made?
h. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
e. if discharge is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
%%�
Frcehoard(inches) ...... `/.................... .................................................................................
❑ Yes
TNo
❑ Yes
!1 No
N 1A
❑ Yes
No
❑ YesNo
❑ Yes
No
❑ Yes W No
Structure 6
116/99 Continued on hack

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes KNo
(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 pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required top of dike, 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? ❑ Ponding ❑ Nitrogen ❑Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ❑ No
21. Did the facility fail to have a certified operator in responsible 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
❑ No.vialations or. deficiencies .were Hated clurin this.visit:. You �viyl.re�ceive no further . .
et fp• sb6ddehce abbot; this visit: ; ;
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):
was 4 clec_k 01.._ CC,gavJA- �e✓��, Gf wa5 &1V (.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 2- N- 5 5 11 /6/99

13 Division of Soil and Water Conservation [3 Other Agency
MDivision of Water Quality
10 Routine O Complaint 917ollow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 3 p Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Registered [3 Certified 13 Applied for Permit ® Permitted 113 Not Opera Date Last Operated: ,
Farm Name: .li!D. i!! . I. ..... IJ�i"�l'�- ..................... ....................... County:...........,... '''��.'1........................................
Owner Name........ ......... E ....... X�-�/©.5 .. �+ .............. Phone No:..,.�1..%� ... :...,r ./... ..................
FacilityContact: ............7 .••.... A?A115; .......... Title:.......................................................... Phone No:...................................................
Mailing Address: ......... �Tf.. .�`...... ../.. �f/ :? ... /...V.... r..P .. .
.may....
yt... .............................
Onsite Representative:.........,(, p ,...... /�� ...... Integrator: ...... �,7VAaA ,f � G......
Certified Operat.or;........................................................................... . Operator Certification Number;................
Location of Farm:
Latitude Longitude
> d� Design Current
vine,-�, Capacity Population;
❑ Wean to Feeder
® Feeder to Finish 7 %W %9ZQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
c
ME
Design 'Current Design Carrel
Poultry ,Capacity Population Cattle CapacityyNpulat:'
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
E` Notal Design Capacity; '
Z
Total SSL W 1,
Subsurface Drains Present �J❑ Lagoon Area J❑ Spray Field Area
.....
No Liquid Waste Management System`
'ural
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated al: ❑ Lagoon PkSpray 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 galli-nin?
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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125197
❑ Yes IN No
Yes ❑ No
❑ Yes N[ No
KYes ❑ No
❑ Yes
tR No
Yes
❑ No
❑ Yes
❑ No
Yes
❑ No
❑ Yes O(No
❑ Yes ANo
Continued on back