470006_INSPECTIONS_20171231

2 V
NUH I H LAHULINA
Department of Environmental Qual

��^�� Divf"lion of Water Resources
Faclllty Number - Division of Soil and Water Conservation
Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z Arrival Time: Departure Time: i gyp„ Countycl LJL Region: C
Farm Name: 120L4 604041 A i—Al Owner Email:
Owner Name: GdD Phone:
Mailing Address:
Physical Address:
Facility Contact: W Title:
Onsite Representative: 64
Certified Operator: V
Back-up Operator:
Location of Farm:
Phone:
Integrator: S.h,�'rf'I
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
DairyCow
Deslgn Current
Capacity Pop.
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
Dry Cow
Non-Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Dr, P,oultr, Ca act P,o
Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turke s
TurkeyPouets
Other
Beef Brood Cow
Other
Other
Discharges and Stream im acts
I- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [5,No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [D NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [P NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes []No ED NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[i No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
{y� NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
—30P
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(� No
❑ NA
❑ NE
(i.c., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
KA No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q9 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 Cjop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): CCQS is IC /� �}
13. Soil Type(s): f p }•t�,_ t ��� j��c,c: %GcS-t'
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
% No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(D No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Ep No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [g No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 . 21412015 Continued

FaMli `Number: 4 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�j No D NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [� No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes C�g No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. D Yes qg No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes q� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments {refert to question #) Expfaln any YkES aris'we'r'ii and/or any addttiona' recommendation-sbor any"
other comineiifs 4
iJsedrstirings'ofi'aciii tfobekferear 'lainsltmuation"(usadditional`_ gesas.necessar• }, .
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Lk 'as'"( Date: �1
Page 3 of 3 2141'20I5

Rig
Division of Water Quality
Facility Number - c-------+ O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (0 Routine O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: p Arrival Time: � w. Departure Time: County: � o
Farm Name: W Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: W OQd Title:
Onsite Representative:
Phone:
Region:
Integrator: 5m rA-41�e10'
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other'
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I E I I Layer
Non -La cr
Non-L
Pullets
Poults
Design Current
Discharees and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Bcef Brood Cow
❑ Yes �z No ❑ NA ❑ NE
[:]Yes [—]No
[:]Yes [:]No
NA ❑ NE
NA ❑ NE
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
1PNo
T)Lrl;nf
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2?�1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
( No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
i� No
`P
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
�g No
❑ NA
❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]No
❑ NA
NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
!�� NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[� NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [3Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
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?
Pa4,e 2 of 3
[]Yes [] No
❑ Yes ❑ No
❑ NA NE
❑ Weather Code
❑ Sludge Survey
❑ NA MANE
❑ NA NE
21412015 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [3 Yes
L] No
❑ NA
jM NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
[]No
❑ NA
[;5NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA K] NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No [] NA § NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
❑ No
❑ NA
NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
[] NA
NE
34. Does the facility require a follow-up visit by the same agency?
iAj Yes
❑ No
[] NA
❑ NE
Comments (refer to questions#):.Explain anyYES..answers and/or anyadditional recommendations or anro'ther cotnment9
Use drawings 'of faeifity to better ex lain situations (ase additional pages 69 necessary).
Reviewer/]nspector Name: M"P, Phone:
Reviewer/Inspector Signature: Date: 0 3 i b'b
Page 3 of 3 214.12015

0v5 JaIjoI!3 DIMS
V Division of Water @amity K'ek✓lttf
Facility Number 0 - ® O Division of Soli and Water Conservation
Q Other Agency
Type of Visit: tfCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: QMoutlne O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: �r
Farm Name: 1v Owner Email:
Owner Name: VV' Phone:
Mailing Address:
Physical Address:
Region.
Facility Contact: Pa,r V Title: [�jvy�p�, Phone:
Onsite Representative: Integrator: �f�1PS1'Slhi� I ►j
Certified Operator: ��W, wo0r� Certification Number: -
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
La ers
Non -Layer
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daily Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes J�j No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes 'Q No
❑ Yes ZI No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

r
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ER No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes fo No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [3 Yes 'R] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 15� No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes �R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
Ig NA ❑ NE
Page 2 of 3 21412011 Continued

piciljty Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 13 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
IS No
❑ NA
❑ NE
❑ Yes
❑ No
1.2 NA
❑ NE
❑ Yes
1! 0 No
❑ NA
❑ NE
❑ Yes CB,'No ❑ NA ❑ NE
❑ Yes [�R No ❑ NA ❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
Dg No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or -any other commenter``
Use drawings of facility to better explain situations (use additional ages as necessary). 4 3s; `
P�e�e.lvorkm rocot: (� �rIrl e, )vl
1,5, Pl�e moue r W luj lead z
E0p r roW ct6~� weij +na�b1"4ed. -Park, (`ecords,
Reviewer/inspector Name: MMA Seh I Pr Phone: Q��4�-3V IULf' 1
Reviewer/Inspector Signature: Date: �_ DOD
Page 3 of 3 21412011

Facility No.t� �Ol �4� Farm Name �� Yy00 Date ala 1
Permit COC ✓ OIC NPDES(Rainbreaker PLAT Annual Cert Daily Pipe)
KIM
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Design Flow (gpm)
Design r _
-
Actual%-------
Diam.--����--
5
Soil Test Date '
pH Fields
Lime Needed
Lime Applied �p
Cu-I Zn-I
Needs S (S-1<25)
Waste Date
- 60 Day
+ 60 Day
N (lb11000 Ga
Crop Yield
Wettable Acres
WUP
Weekly Freeboard -�
1 in Inspections
120 min Insp.
L;ooes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
MOM
..
..
ilk
i
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 101910-) FRO or Farm Records
Date last WUP at farm Lagoon # 3a0kaD
App. Hardware Top Dike 51.,
Stop Pump 5�
.16
Start Pump �,_C7 19
Conversion- Cu-I 3000= 108 Ib/ac; Zn-1 3000= 213 lblac

Wn& `)I7d14IZ.
Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4D Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Qia+ Departure Time: D: O County: Iy Region: POAD
Farm Name: t-, Owner Email:
Owner Name: G✓ d Phone:
Mailing Address:
Physical Address:
Facility Contact: %✓r WDO Title:
Onsite Representative:
Certified Operator: h
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
integrator: L5,,yh �5,,5
Certification Number: ;?o 31�
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Dischar¢es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Daiiy
Beef Stocker
Beef Feeder
Beef Brood Cow
[3 Yes J�jNo ❑NA ❑NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
IP NA ❑ NE
®NA ❑NE
�o NA
%❑
❑ NE
NA
❑ NE
❑ NA
FINE
Page I of 3 21412011 Continued

i)
Facilfty Number: - Date of —inspection: B
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
® No ❑ NA ❑ NE
[-]No RNA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
4
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): sra.l %�+'Az A... Ot
J'�
13. Soil Type(s): , G,4Ap ( , 4u — Ume
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LP No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ea No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
(P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[19 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ER No
❑ NA
0 NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EP No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [3 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - jDate of inspection: 2%
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [Po ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes (n No ❑ NA ❑ NE
❑ Yes ' CQ No [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 5Q No ❑ NA ❑ NE
❑ Yes No
[:]Yes No
❑ Yes 1 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments ,4 ;i
Use drawings of facility to better explain situations (use additional ' a es as necessar } ; 4' '�;"�5'<F" 4=
,0.•rr ..���
Scl,:4 ar_l� rC " 4- j4o-�— -�a p
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7/Q _'33 336
Date: 9 t24 Z
21412011

Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
w
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: Q w Departure Time: Q,' County: Region: floep
Farm Name: �pQd _ ire Owner Email:
__ 4n
Owner Name: CCt Phone:
Mailing Address:
Physical Address:
Facility Contact: VD W Li, w0j, Title: Phone:
I
Onsite Representative: Integrator: y��,kLt1,r )g4d0 $, �
Certified Operator: t't Certification Number: -�03 j;,
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
iTurkey Poults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes CQ No ❑ NA ❑ NE
[:]Yes [:]No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
O NA ❑ NE
M NA ❑ NE
®NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

1
Facility Number; P I - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. 1
Spillway?:
Designed Freeboard (in):
-"T
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste AP lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
r 13. Soil Type(s): bl" !LA , �� ?(� rd 6, \Ja.J �dSP _ VC6
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes V9No [3 NA [3 NE
❑ Yes P No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
[
the appropriate box. 1
❑WUP [3 Checklists ❑ Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fE No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

i
[Facility Number: Date of Inspection: Bit 111
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
T
[� Failure to complete annual sludge survey C3 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes TT No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any -other, comnWnts
Use drawings of facility to better explain situations (use additional pages as necessary). Oil:
Reviewer/Inspector Name: Vo [ a&Q IP - Phone: gt07gL-3300
Reviewer/inspector Signature: Q Date: 9 11 L r
Page 3 of 3 21412011

Facility Number
_J
0 Division of Water Quality
O Division of Soil and Water Conservation `t
O Other Agency
Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technlcal Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t9 Arrival Time: Departure Time: County: #19kk Region:
.A 1 .-..- rr-
Farm Name:
r
Owner Name k It
Mailing Address:
Physical Address: QQ
Facility Contact: _.►`bT 0, L'J"'j Title:
4�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Uuts
Boars
z
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: �203/ 2
Back-up Certification Number:
Latitude: [= o = 6 = longitude: = o = 6 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
y w ❑Non -
La er
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?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: MJ
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 49 No ❑ NA ❑ NE
❑ Yes
❑ No
50 NA
❑ NE
❑ Yes
❑ No
'NA
❑ NE
(§ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Humber: — Date of Inspection e O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
j No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
tpNo ❑ 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
kNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
MNo ❑ 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
5No ❑ NA ❑ NE
maintenance or improvement?
Waste Al2plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No Cl NA] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
U. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
Ir NE
t5. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
[:1 NA
[§NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
nNE
{ z. , . yxl i�i` c 1� t A4':]
Comments (refer to question #):" Explain.any YES" answers and/or any Erecommendations or any othercamm ents�. ; �^
❑se �4rawings.of�faciiity�to, better -explain situations. {use additional pages asgnecessary)-, n A$ • �� �
reds [�-�►�.rc o� �� r�ec.� Sow
�� 9/�d�n .
Reviewer/inspector Name -- -' s" . ;;�
Phone:
Reviewer/inspector Signature: "
Date: %
Page 2 of 3 12128104 Continued

Facility Number: �—y Date of InspectionLt[[Q[[QJ
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 ❑ No ❑ NA [ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
El NA
NE
q
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NOR
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNo
❑ NA;NE
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ERNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NXA
� NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑
NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
T NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
NE
General Permit? (ie/ discharge, freeboard problems, over application)
I
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
1� NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
f� NE
Ak ditibnam l'Comeitts antllbe Drawings
AL
Page 3 of 3 12128104

F>
(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 119 I Arrival Time: 08 `LD Departure Time: County:
Farm Name:7"o-vio/co rvr►v%' Owner Email:
Owner Name: V), WC0
Mailing Address:
Physical Address:
Facility Contact: Poy Lj. Wozd Title:
vl
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:. e4 �lvt
Operator Certification Number:
Back-up Certification Number:
i/
Region:
Latitude: = c = 1 Longitude: = ° ❑ i . ❑
Design C►urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dai Calf
Feeder to Finish
00
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
El Dry Cow
ElFarrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
ElNon-Layers
El Beef Feeder
El Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Other 1110
ILI Turkey Puults
Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes F�No ❑ NA ❑ NE
[:]Yes
❑ No
;G NA
❑ NE
❑ Yes
❑ No
IFNA
❑ NE
❑ Yes
❑ No
L:�NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
$bNo
❑ NA
❑ NE
12128104 Continued

`- Facility Number: — Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [4 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes %No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [2�No ❑ NA ❑ NE
through a waste management or closure plan? .
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;5 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as -necessary); . f'
Reviewer/Inspector Name
T pr I Phone: 91P 3 -33Qo
Reviewer/Inspector Signature:
LL SL 19adk& Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E� No ❑ NA ❑ NE
the appropriate box. ❑ WDp ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �a 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
1�[No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
q 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
[PNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EN 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
;9 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
f4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[B No
❑ NA
❑ NE
Additional Comments and/or Drawings:
S ,52 r S 201 D
Page 3 of 3 12129104

sIM.5 ovs ala316
ni
Facility Number ppa
QDivision of Water Quality
0 Division of Soil and Water Conservation 3 ,
0 Other Agency,.-
Type of Visit (*Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit G'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: $� Departure Time: 10' 30 County: ' 6ke_
Farm Name: Kdy �r rU(I7 Owner Email:
Owner Name: Phone:
Mailing Address: S4D .�W/Ilrttw �P� �i Ph/Ci�
Region: r 120
Physical Address:
Facility Contact: Mond Title: Aker- Phone No: JOQ-4i t S'O
Onsite Representatives: Integrator: FL&A SM ih
Certified Operator: VV04 _ Operator Certification Number: CX91a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = « Longitude: 0 ° 0 I = 11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
II IEJ Non -La ez
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp," & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design C
Cattle CapacityTo
irrent
ulatidw,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Caw
Number of Structures;
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 5,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
[I NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
j No
❑ NA
❑ NE
12128104 Continued

Facility Number:4-) t Date of Inspection �Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 99 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): O
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
99 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
12 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
YNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[�JNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ffNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN [--IPAN > 10% or ] 0 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
CR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EWNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CKNo
❑ 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 �d/4rV SG I E 1 C IZ Phone: 43 - �
T
Reviewer/Inspector Signature: Date: Hm Q
V 12128104 Continued

Facility Number: —� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I'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 Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IRNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No R NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
aNA
❑ 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 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
W 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
I@ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or larawingss:14'+, �m z �...afs.,
15, Nit 4-Rc-Fded s��� -3eldb 1,st wee4 [4rweeds7
NA, M Ach 6e , E; e06 0)1 "Mon on S ?de
Wel MA-101 k 4VA, 4 9aaL rerads
� ��ed�o• dar,i� cah'b�� �►�, �UrM>� cgny �
A
Page 3 of 3 12128104

Facility No.4'"606 Farm Name
Permit ✓COC
�a �^Oct� t�lr Date ' oZ
OIC_ NPDES (Rainbreaker PLAT Annual Cert )
'13
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date I 1,rJOT
Sludge Depth ft & %
�.
Liquid Trt. Zone ft
'_+ I
r
-01
Soil Test Date 4«oS 'm�Ad Crop Yield 120 min Inspections
pH Fields Wettable Acres Weather Codes
Lime Needed ✓ - WUP Transfer Sheets
Lime Applied ` Weekly Freeboard RAIN GAUGE
Cu Zn�� Rainfall >1" ✓ Dead box or incinerator
Needs P �_ 1 in Inspections
�m old D(a, 1446'
. ,..r
won-
"I
\I
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
®or Farm Records
Lagoon # S
Top Dike 571Y
Stop Pump 53.E
Start Pum .g
` 3�rt0
31
1
..0
�s kgba`�a4w�tFk �1
App. Hardware

11
10 Division of Water Quality �"��
Facility Number 0 Division of Soil and Water Conservation If
O Other Agency
(Type of Visit *0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: ® County-
' bo �1 rf FcLr (A Owner Email:
lA)CQ C Phone:
Facility Contact: KDU UO L___ Title: ti. J umir Phone No:
Region:
Onsite Representative: u Integrator: (L r 1
Certified Operator: cl Lk J00 8 Operator Certification Number: lJ J r
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = e = i = Longitude: = ° = 4 = N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
^1 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream lml)acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Di sign Current;" .
Cattle Capacity .Population.
❑
DaiEX Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
EJNon-Dairy
❑
Beef Stocket
❑
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?
❑ Yes q9 No ❑ NA ❑ NE
❑ Yes
❑ No
N NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )6No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes h No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in): t
01
Observed Freeboard (in): _ 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 V� 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 'V§.No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes VNo ❑ 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 1% No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? ?Q
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) ��, t,l, C r Q S
13. Soil type(s) Q e C ; l c—c- (�
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
Wo
F No
[� No
No
No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
— I reg CSJtt f S 6*-r t - g L1 D + � Y1r-j c'k
Reviewer/1 nspector Name CN PI j f L Phone: 33 a�
Reviewer/Inspector Signature: Date: Q, D
12128104 Continued

r
Facility Number..'IFDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'PrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes )§ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
*& NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jKtNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'p5t,4o
❑ 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
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�K No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
I I- / /reel
_11�� �— DWPneV iS .riS-1 j nr7y�,tro,t s v-tzm [tu s sp r l- y�,�
JJ V X
12a8/04

Facility No. i_ o Time In 13y Time Out Date 0
Farm Name I Integrator 1 k
Owner 0 LA)Md Site Rep
Operator No.
Back-up No. _
COC X_ Circle: er or NPDES
M
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
We
Farrow — Finish
Feed — F' '
Gilts / Boars
Farrow — Wreian
Others
FREEBOARD: Design ref
Observed J
Crop Yield O
Rain Gauge
Soil Test �r 9-111lettable Acres v
Weekly Freeboard L___
Spray/Freeboard Drop 1
Weather Codes
Daily Rainfall v
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
l 2 .�
S j 2.7?- o --7� �•�
Sludge Survey ✓ c "—ut
Calibration/GPM / 41 I
Waste Transf rs
Rain Breaker
PLAT
1-in Inspections
Fwti tomN
0%,
Date Nitrogen (N)
. Z] JtQ 2.1
Pull/Field Soil Crop Pan Window
,, toll — 3 !

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation 1
O Other Agency
Type of Visit C1 Compliance Inspection 0 Operation Review 0 Struciure Evaluation 0 Technical Assistance
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: n' �{�-,Arrival Time: 0. Departure Time: County:
Farm Name: ']�- `,t Owner Email:
Owner Name:— ! 7V Phone: _
Mailing Address:
Region: _�'� �_ M
Physical Address: `
Facility Contact: 1��U.� C Title: X Phone No:
Onsite Representative: Integrator:n���
Certified Operator: Dm UV Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 6 ❑ li Longitude: = ° = 6 0 {I
Design Current Design Current
Capacity Population Wet Poultry . Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
l . 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, .Populatioi
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d, Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
r
4
❑ Yes [d No ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
19 NA
❑ NE
❑ Yes
❑ No
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: 41 — pQ(p Date of Inspection 7 'f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,,cc
NNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(iel 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?
k4kYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[]Yes
[WNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl El Application Outside of Area
Ii
s) � m t l id�i i + G! ' n OS
12. Crop type1
13. Soil type(s) t
14. Do the receiving crops differ from hose designated in the CAWMP?
❑ Yes
#5d No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes]
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[R No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MIVo
❑ 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):
/--Ac &woA / safcm�l P &7 beck
AL
f�}►'IILI" f� � �OI'! �
rr��
PULE rtpy4 9loin r04es dU_r1>� CAtc�G4ilM k
ReviewerlInspector Name 1L, �}'["QjJ Phone:0-y-1 0 433 _
Reviewer/Inspector Signature:C4aa:��,Date: a 1
12/28/04 Continued

r
Facility Number: Date of Inspection �u11
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [X 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
[3kNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge`?
❑ Yes
CR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
*o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
*No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
N 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
Wo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
n No
❑ NA
❑ NE
Additional Comments and/or Drawings:
pK S-t o, tl p.ZC- �. o, �e�r _ I �C P� C�r
v C Lt c. k c&-% SR4„51]r�
N --a � 4-51- P. d 'Ve. &941 Q�,u 7 za
PA—E kecr,,f—
G�
.. Nob- ; For Val-u--ns % (0_aL*e.y , haci 4o r
�Q
WAS Nc '
Qori` xc� oujLd ce �� mtx e. ► n-�`c�rrnQ�t
12128104

}Facility` No. _ { �Time In
Farm Name
Time Out
Intel
Owner �&L=LU �� _ Site
Operator _ � 002hr '� _,.., No.
Back-up No.
COC Circle: General or (:ND
C
Design
Current
Design
Current
Wean = Feed
Farrow — Feed
We — h
Farrow — Finish
eed Finish
c5u
Gilts 1 Boars
ow — We96
Others
FREEBOARD: Design Observed
,Mudge Surve Calibration/GPM _ ✓ 1
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Dropt�oj
_ 4
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
OkD o -
�1�0 Z-kp
T
Date Nitrogen (N)
'31% ---2-1
■
a
■ ■
r ■
WE
��
I
1

Type of Visit (";Zoutlne
ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date or visit: 7 Arrival Time: Departure Time: County: O� Region: �""'
Farm Name: d �Tr
f ~ Q-frn Owner Email:
Owner Name: WM)CL Phone:
Mailing Address: U r I I ce U ne U vS QCfJ�
Physical Address: r L A 62�
Facility Contact: d Title: 0 W MZ Phone N
Onsite Representative: 0 CM �_ ( Integrator: Y h
Certified Operator: 1( Operator Certification Number: o
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e 0 S = Longitude: ❑ o = 4 = u
Design
Current
Design Current
Design Current
Swine
C►apacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Layer
❑ DairyCow
❑ Non -Layer
❑ DairyCalf
El Dairy Heifer
Dry Poultry
❑
❑ Non -Layers
❑
ElTurkeys
❑ D Cow
El Beef Stocker
El Beef Brood Cow
ElTurke Poults
El Other
Number offs
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
(]
to
❑ Farrow to Wean
❑ Farrow to Feeder
&Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes $No ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
I.�NA
{�1A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ 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?
[I Yes
� No
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
N No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3 12/28/04 Continued

Facility Number: —00(p Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
.Structure I Structure 2 Structure 3 Structure 4
r.
Identifier:
Spillway?:
Designed Freeboard (in): t�
Observed Freeboard (in): t
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 )T&o ❑ NA ❑ NE
❑ Yes ❑ No I.NA ❑ NE
Structure 5 Structure 6
❑ Yeso ❑ NA ❑ NE
❑ Yes _lo ❑ 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 )<No ❑ NA ❑ NE
S. 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 0 Yes o ❑ NA ❑ NE
maintenance or improvement? JJJJJJ ���-
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? )4
11. Is there evidence of incorrect application? if yes, check the appropriate box below. 19Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
15�2AN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)6D�M_&L&✓Q.t .
13. Soil type(s) -F)t0olex.... ; G i l le
14. Do the receiving crops differWom those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 'IRtNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes.'V No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes "*%No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes & No
❑ NA
❑ NE
t6
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):
11 . ro un� S1 i h 4
clev ,- cam. l PiY✓a /` r erne
ap 1,,
ReviewerlInspector Name
s�/
Phone: 333,3oo
ReviewerlInspector Signature:
Date: U lYi 24D
Page 2 of 3 121281V Continued

Facility Number: —(f ( 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 No
K
ElNA
❑ NE
ElEl❑ Design El ❑ Other the appropriate box. WUP Checklists
//
21.
Does record keeping need improvement? If yes check the appropriate box below.
1,l Yes ❑ No
❑ NA
❑ NE
4#aste 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?
❑ YesNij?No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 19 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes i&
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes P�Jqo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No 'XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes 0 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 ANo
❑ 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
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
I _
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �ao
1*No
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
kc\ , 0 I rcd 2cD 3 1,jo1A CW `
y met `�o s b 4 ;n ci i G0-✓reh 4 C C. ao Swn aj Pam; bk
2 5 pie `�v hr)Lv- uxoz ava
1 0 r
e Su�c -�o u52. 0fPf0Fr,a-Pe_ SaMPk Cana s l3 Ar QjaC�
CO-� ,
KeeKg_ l i�i£.wL YIf C zpcLirk'C e -Pb { f'CA-CA - 1 t( d. Wla
p
o y eQd c a f seams n,
D 15 C.1.L 55 C -f�' w 4uyr e n -�o S1F c� $ ,f'e m �V ,' S2pQ �'a r rye,Dwk �J ,, 1' ca
Page 3 of 3 12128104

j , . 0
FacilitY Number l l �' tD Date `� Time IN, f 6� Out
Owner
Farm Name
O.LC" No.
-----C.O.C. General D
Design Current Design Current
Wean to Feeder
e e to .fig (a Farrow to Wean
Farrow to Feeder Farrow to Finish
Gilts = Bows
_ .
,
�` 5oii types
G; 1 OD4
Crop Types -MJQ Par an Window 3 -
'
Soil Test Plat
Designed Freeboard Observed Freeboard
fl �
Rain gauge �R n breaker Daily Rainfall Waste Transfers ^�
Calibration of spray a ipment �G.P,M. Q n ri,✓
Sludge Survey Crbp Yield V 120 Minute inspections
1 in. Rain inspections �-�' Weather code' . ' 'Weekly Freeboard
Pumping time
Waste Analysis % & Month�3
Comments

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: -/ 0 -a Time: O
Not O e tiona Below Threshold
0 Permitted © Certified [3 Conditionally Certified [3 Registered pate Last Operate�d%r Above Threshold:
Farm Name: �� `+J• tTl- �� _ County: -p /<
' Pdu �7� rJ
Owner Name: � Phone No: 4V
Mailing Address: _ �� �l D'I' t e `_ . /tw v o r&o l-'
Facility Contact:
Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �_� a I 0 u Longitude 0
I
Design €';;, .C,u'rrent ',
iAnntity` Pnneilgtinn
Wean to Feeder
Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
[] Farrow to Finish
❑ Gilts
❑ Boars
r
:cl�lYtamber; of Lagoons ,
Holding', Ponds'/, Solid' Traps1
E
Non -Layer
Discharges
&c Stream Impacts
1. Is any discharge observed From any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Spray Field Area
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Identifier:
Ir
Freeboard (inches):
05103101 Continued

Facility Number: -- 6 Date of Inspection I -1 n - o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. ATe there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
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 ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ 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 at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
^•r�,nrx,:� ^-rMaaas••��n+�u.ti: �z�p�.....�.�_..w.�..,� _. 1� � �^errac�:�rwpm*.rk...rr-r:�.Y:rarr:,�±€+:,x u,��w�e::�nr•�.gz«,<�....,., ,�, ,; -
Cam�nents,(refer to questonn #) Facplain any YES sucswers"and/or any reeedatioas or athercamments.
mrr �a^ .��.:�.: u
Use drawings of ity to l tber,gtpiatm situatioffi. irz=. dditiieinal�pai...... ❑ Field Copy ❑ Final Notes
i nt i ' 11 �,. RF `r�'�94 ®. a
Reviewer/Inspector Name `USE M4 m5%,9
ReviewerfInspector Signature: Date:
12112103 Continued

\\f
� �,��'.�lf••� ���€�� d�€S' ,G�'�'�.'^iiS:'irktr&ts.r ,Tr'�'. .'; �°`k,C.. .�., �, „Ic7T.�"e+*"��'14 "`ova '� y7,k't`� y - � �" r o. ?�,.a,
,�"�' �{�+E, `��q,E= '�:�° ^�� '« : ��� ° ,iu e ' � Division of„Water Qdalit3'r��R'�•".��'�� � i �`r �`,.!�,�'+;�' � �?- �� .arm � .�� ��`� �,�,� :,� 1 r•,, „� �: a'.
�� wi��t€a��C�;r`i�i d � € i at�3 i" 'd€� 4r �:5 �., i.R$€:�r�k��c'�ie 4 .ad9 ��l� ��' ��,'"� eKEF ,�•'�` , � �' ! � �a �::,..
•f�t€n.f+� ? ��{, r r'� € t 9: �h r 3 � .[ itr �1e �:l�' a f,�i t F. .� i iy �.. f� i <-.r, �a ' ,.,�: _
-. E .$ad..'�do-'{�;`�'lF�...�r� i!Pb��s}� �� � ��ie��� �.;�,� ���w �.u� i�•i� ,� aa- §�;f. i z«.dua .. . , ...r r d t � . ��,.8..��f ...5. ... .... _ . _ .........._ t ......_
r
of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
n for Visit ®Routine Q Complaint Q Follow up Q Emergency Notification Q Other © Denied Access
Facility lumber Date of Visit: Time: 3 ;
10 Not Operational Below Threshold
® Permitted M Certified O Conditionallh• Certified © Registered Date Last Operated or Above Threshold:
Farm Name: Kn �; Wood Sr. F& "„ Count%- _12?ItQ
40
Owner Name: K0_ Phone No: __ i O/ g 3-5 -- 12 3�-
Mailing Address: Ot I.S 1ro_Sa eck- Aut.. . C
Facility Contact: Dto lAn o a Title: Phone No:
OnsiteRepresentative: 2���Qo ____ -_- Integrator:
Certified Operator: Operator Certification Number: 6 -
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude Longitude �• ���
Design Current
Swine ranneity Panulatinn
Q.Wean to Feeder
® Feeder to Finish
a
al &n
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Ca acity Population Cattle Capacity Population
❑ Laver I ❑ Dairy
❑ Non -Layer I I Dairy
❑ Other
Total Design Capacity
Total SSLW
[] Subsurface Drains Present ❑ Lagoon Area S rav Field Area
`; ❑ No Liquid Waste Management System
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharne originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen ed, 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
Structw• 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 436
05103101
❑ Yes [3�;No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Q0 No
❑ Yes
®'No
❑ Yes
P No
Structure 6
Condnued

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 �(] 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
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste placation
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type 11S�111u Af— J_ "J------- - - -
13. Do the receiving crops differ with those designated6n the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M 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
Reguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
19.
Does the facility fail to have all components of the Ccrdficd 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
9No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(D 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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer.to qu6tion #E): Explain any YES answertandior any recommendations or anyiothcr comments
,..
aUse''drawings of facilltyAta better explain situations. (use ad_ditionalpagcs as necessary) ❑Field Copv ❑Final Notes
F17.,ft, , 0 l.4itX t'p GY
4JS�
�.�Vj LA -A Get'g��c K" d-s
A CZ Fq'd . 1p-! V d t tre c�.�-� a� -.rc Gc L �,�.n.�� Se--k 4V7
Reviewerllnspector Name t
Reviewer/Inspector Signature: 4 L Date:
05103101 Continued

Facility Number: '-�- — Date of Inspection 3
Odar 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?
29, 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?
Q
[I Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes �] No
❑ Yes F; No
❑ Yes P No
❑ Yes ❑ No
05103101

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of D%VO insix-vtion O Follow -tap of DSkVC review Q Other
Date of Inspection
Facility Number Time of inspection ti 6'r7 24 hr. (hh:mm)
❑ Registered Certified © Applied for Permit © Permitted O Not O erational Date Last Operated:.........
FarmName:.......... P�2 ..1... r. !M................. County: ...... z4t.....................................................
Owner Name:. —A. ".t.A..... [ uo.. ' f
�... Phone No: S.................................
Facility Contact: ... .¢. ...... !!!................................... Title:..1.1t�.Aar ...... .......................... Phone Na:... Z ..�2..3.7.......
Mailing Address: ......q-1..2�........F-s- ...................... ...... Act ��Cf�.�....I...Y..C-.......................... 2V.-Y%.k7
OnsiteRepresentative:... d.t�......i!11Q. .. ........................ Integrator:z�.( h�...Fqr'.
Certified Operator;...... E1... .....r,A/............................................................. Operator Certification Number .........................................
Location of Farm:
Latitude • ° it Longitude ' ' 0"
Number of I agoonszl Holding Ponds L Subsurface Drains Presentjj❑ Lagoon Area Jp Spray Field Area J f
e
` ... -:..
❑ No Liquid Waste Management System r
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
Is any discharge observed from any part of the operation?
❑ Yes
o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b, If discharge is observed, did it reach Surface. Water? (If yes, notify DWQ)
❑ Yes
❑ No
e. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system'? (If ycs, notify DWQ)
❑ Yes
❑ No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
ko
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ANo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
4No
maintenance/improvement?
6.
Is facility not in compliance with any applicable .setback criteria in effect at the time of design?
❑ Yes
toNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
eNo
7/25/97 -
Continued on back

Facility Number: — Q
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (1-mmons.Holding Pon Is Flush fits etc.
9. Is storage capacity (freeboard plus storm storage) le \
ss than adequate? ❑ Yes 10
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):............�.f.................................................................................................................................................................................................
to, 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 P'ltlo
12. Do any of the structures need maintenance/improvement? ❑ Yes 5No
(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 ANo
Waste Application
14, Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering w ters of the State, notify DWQ)
,r- van u [a:
15. Crop type...............�.....................�,,............./��-�.......,................................................................,............................................................................,.
16. Do the receiving crops differ with thos 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 Reviewerlinspector fail to discuss review/inspection with on -site representative? ❑ Yes No
22. Does record keeping need improvement? ❑ Yes o
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes o
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes tNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
No.violtitions�ar. deficiencies;were;noted,during this:visit., You.v.0 'receive no.furtlier:'
corregpi)Wke Atiout this:visit.•:: .
9 �. n � �` .. - - y "�-••YffiRY'.itl't'<. C•a.f`a+ - - "•... FVJ. A.a'Awn'A�SiVtnd .�' h >. i i --
_' m 6ts (refe 46, question #) Explain!any YES ains*e' is andl r any�re�commendatjons ar`anylothe�rcamntents ,
IJse drawings of facthty to better:ezplatn sEtuations, (usc addtfional pages as:nece5sury)� �, ' , ' .. s >
7/25/97
��.>,......-...... `v....,... .j..-�..� .. ..-..«-. __ ......, � w,.....+. ,..-.-«... mow.....,.....--f }
Reviewer/Inspector Name 1 ` ` �w
ReviewerA ns pect or Signature: ,, Date: 1 7 —11-9