310805_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: Q Co'pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emersency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address.,
Physical Address:
Facility Contact:
Arrival Time: Departure Time: County: t Region:
OnsiteRepresentative: k(-- �odA up'lw
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: q 5 2 b
Certification Number:
Longitude:
in
Wean to Finish
Design Current Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop. C*attle Capacity Pap.
Layer Dairy Cow
Wean to Feeder
Non -La er
Daig Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
1 1R_f9_ign Current —Dry Cow
1) , P.oultr, Ca .aci P,o Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes % No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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?
D Yes ❑ o ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes []No [] NA ❑ NE
Structurg I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; U ,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23
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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s): i
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes dN
❑Yes LJ11
❑ Yes io
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ YesDKo/ [] NA ❑ NE
ReAuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes L.D Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes r�,Ado ❑ 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 P ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections P
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faclli Number: - Date of Inspection: j J j
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25 � Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo ❑ 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 EfNlo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F�fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[✓JNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ /No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L'J o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
CommYYeii�{tyyys}}°��SrSefergtto9uestiion #, y''Erx ylga�inc aii 'YES apngs{w,eyr'syandlorg'{'aii`sxd'gdyitiognyalrecomineid'a,'tions'or anotterjcomineiifs.'° `q
,.�.�Yel6'ElY.�t TkT �-ps".6I E�i %-Y ��M. ., hF�..'1'.9���,iM�f+'Ja SWiI_k�'�� ._., i:, �. .�$ �, 1S'ty.'; �'I Ff �. `:i2�
Use drawinks. di facilitv:to;better�,explain situationKfuse.a�dttio,n8l�pa�esias necessary�)� m ,r � � . t ,.
� r
Reviewer/inspector Name: J UG t, i ✓ Phon i� 6 "ve
Reviewer/inspector Signature: ----�( Date: 5 i
Page 3 of 3 21412015

EJ
(Type of Visit: -0 CCopliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency p Other O Denied Access
Date of Visit: Arrival Time: Departure Time: Fq'Z___� County: 0,)eRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 43-Tk Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 9 U 6 7 1
Certification Number:
Longitude:
t
is Design Current
i
Design
Lounrent
t i'
Design Current
SwineA
Capacity Pop.
Wet P,oaltry `
C►apacity
Pop.
Cattle
Capacity Pap:
f
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Curreint
Dry Cow
Farrow to Feeder
Dr, I;oultr,
Cataeit
1',0
Non -Dairy
4
Farrow to Finish
ILa
ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther, `
Turke Poults
Other
�Ea�3scarza�rxa�L�caaaauc s:eraaa�ass �++e�a�F
Other
.a��a��c
Discharges and Stream Impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 9�N o ❑ NA ❑ NE
❑ Yes
❑ No
[DNA
[]NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Incility Number; - Date of Ins ectiow.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? Dyes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (,A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ 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 environmtal threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes a o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
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 V) o
TTTT
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
C] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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 dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

F cilit Number: -_j Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
"bther Issues
Did the facility fail to properly dispose 6f 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 the 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?
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
11
-Ve 11i�y
❑ Yes ✓ No ❑ NA ❑ NE
❑ Yes Z/No 0 NA ❑ NE
❑ Yes fo ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes C '' o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
Phone:
Date:
21412015

Type of Visit: Q Co liance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 i Arrival Time: 0 Departure Time: � County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: t�e dt, �lu iCt_ Integrator:
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wet Poultry
Design Current
Capacity Pop.
Design Current
C*attle Capacity Ep..
..
Wean to Finish
Layer
iry Cow
`i
Wean to Feeder
Non -La er
DairyCalff
Feeder to Finish
Design Current
iry Heifer
Farrow to Wean
1 Z
Dry Cow
Farrow to Feeder
Dr, P,oultrF
Ca aeit P.o P.
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
a
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Ql�o 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[� o
❑ NA
❑ NE
❑ Yes
WNo
[DNA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - Q Date of Inspection: 1 /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan'?
❑ Yes N[�o [DNA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
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 dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�(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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No,
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
194
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
EJ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3"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
❑ o
❑ 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 ❑Other: 11
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and t" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: / r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ErNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D'�10
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
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?
Reviewer/Inspector Signatut
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
3<A ❑ NE
❑ Yes E5"No ❑ NA ❑ NE
❑ Yes [n—No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[]Yes (ffNo ❑ NA ❑ NE
❑ Yes C�No
❑ Yes rNo
o
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
—.ay. 1
Date: It 7
it 1
21412015

(Type of Visit: U 7Routine
pliance Inspection U Operation Review U Structure Evaluation p Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County:D jP(�Z� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: j Title:
Onsite Representative:
Integrator:
Phone:
Certified Operator: Certification Number: q q ' 1 6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
�IggItesi Current
Swine Capacity Pop.
Design C•ur:,rent
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean j bd
Farrow to Feeder
a
Design Current
D , P■oultr, Ca acit P■a
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream lmyacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes ZeNo ❑ NA ❑ NE
[] Yes ❑ No ❑ NA [] NE
Yes ❑ No ❑ NA [] NE
Yes NA NE
Yes � NA [] NE
Yes YNo NA [] NE
Page 1 of 3 21412011 Continued

Facilit
y Number: Date of Inspection: ( S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a/No ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2 Structure 3 Structure 4 Structure 5
U aget').
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta 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 dNo ❑ 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 . ' ._ ❑ NA ❑ NE
maintenance or improvement?
Waste Application ./ 10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No [:3NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Vo ❑ 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):
I4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [3 Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L:''o [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 12<0 ❑ 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 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 [ to ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

]Facility Number: 13- Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes VNo [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E i10
❑ 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 ENo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Yo
❑ 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 o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes YNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P'N C-1 C Phone:(90)216_ 3w
Date:
q/1VIg
l/4 2011

Type of Visit: 0 7outine
liance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:Ai� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �E=� f"IZ
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 79 %d 7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Design Current
Layers
Dai Heifer
Farrow to Wean
b
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
rer
O7!th:er
Turke s
Turke Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4As 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 I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�No ❑ NA ❑ NE
❑ No [DNA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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 6 No ❑ NA ❑ NE
[:]Yes (Z/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 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 Q/No [DNA ❑ 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 E2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[—]Yes Q No
❑ Yes 2�10
❑ Yes E(No
❑ Yes EfNo
❑ Yes C31NO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes E]"No ❑ NA ❑ NE
❑ Yes F71/No [DNA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �io ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 51- Date of Inspection. 13
24. Did the facilityfail to calibrate waste application equipment as re required b the permit? Yes o NA NE
pPq Y P ❑ ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rNNo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 571
❑ 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 0 No ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes Cj N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes 0 rNo
❑Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Date: dZ-(l t 3
Page 3 of 3 21412011

(Type of Visit: © ;rRoutine
pliance inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: �'� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: J .e=k N8ZLL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Fo 010 10
Design Current
11 Wet Poultry Capacity Pop.
I ILayer I
Design C►urrent
C*stile Capacity Pap.
Dairy Cow
Wean to Feeder
Non -La er
I
Dai Calf
Feeder to Finish
I
Design Current
Dr, Poultr Ca aciMrLop.Non-Dairy
Layers
Dairy Heifer
Dry Cow
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Pullets
Turkeys
Turkey Pouits
Other
Beef Feeder
Boars
Beef Brood Cow
Other
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?
❑ Yes No ❑ NA ❑ NE
[]Yes []No
❑ Yes []No
❑ Yes [:]No
❑ Yes o
❑ Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection:
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 I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 221
KNo ❑ NA
❑No ❑NA
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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 7No
NA
❑ Yes ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesTN,o
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes [Z/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes E�'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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V
❑ 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 ffNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? In YesrNo
- ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciH6 Number: - Date of Ins ection: -V
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes _M� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [r No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes LCJ Zo ❑ 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 V No ❑ NA ❑ NE
❑ Yes dN ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C?I�o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q5/0
"o. ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [DNA ❑ NE
Comments (refer, toaquestlon #) EzplMfi any �YES;answerssand/or any,additional recomi4iendatio'n' or siny ptiierfcoimnnents , 1
.5L>1;, e s '' rfTaki: +� ,ti .w. 3 frx Y �M is 4
iJse.ilrayvin�soffacilitytobetter:explam,situations(use;additional;pa�esasnecessary)r�`,§,�
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: EQ — Ikj
Date:
21412011

0
Type of Visit: p C pliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: y Arrival Time: Departure Time: County: 1L Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: H AT e Q
Certified Operator:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
C*urrent
Design
Current
Design
Current
Swine Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
airy Cow
Wean to Feeder
airy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Drr P,oultr,,
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
thTurke
ro
Poults
ther
I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VN o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4.'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier: LAC72aJ
Spillway?:
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in): cc
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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 d No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �/No ❑ NA ❑ NE
maintenance or improvement? 777777
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 [71/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 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):
U. Soil Type(s):
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
t5. Does the receiving crop and/or land application site need improvement?
❑ Yes [7No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ENo
/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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 dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -qUDate of Inspection:
24. Did the facility fail to calibrate waste application egLipment as required by the permit.
❑ Yes
dNo
❑ NA] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
�Z 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
Ef No
[] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
12No
❑ NA ❑ NE
Other lssues
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
C:fNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E5 No ❑ NA ❑ NE
❑ Yes Qio
❑ Yes [:�rNo
[] Yes [ 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otli'er comments.; .
Use drawings of facility to better explain situations (use additional pages as necessary). ,
)tj CA
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�v 44 �J Phonk 4?16 �, -
Date: i
21412011

10.
ljivisionl ofWaterjQualtty
Tactlt}��:NumbeC= Q,lllvisianof Soil and Water Conservation #. 4
�.1 �I, a •J tJ k ..a:a€�x..c5h rc"- j'as{ %.affi-`+' R - a.. ' i �__
10,
QaOtM�Agencyn�
Cype of Visit. ,C�o/mpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for Visit ( Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rj b Arrival Time: gaU Departure Time: County: DUL-1:0 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ` =" Longitude: = °
Design Current J .Y DesignCurrentIk r t; Deslgn'> Ctirent `
Swine: Capacity ;Population• ,: } `Wet Poultry 'Ca' aci ;Population �t Catfle� � ' ;'3`Capacit°y '<Population�
3 y
- z�, _ £m'U ie.
❑ Layer
❑ Non -Layer
4
Dry Poaltry� 1 g
,'.
>F
ry
i f.
3Other.f♦♦� a ss y j#c:r+ P r�; l�
;'f A tt .' 1
❑Other r `l Ntimtierof 5tuc�tures` h3
J 0�
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
Farrow to Wean
d�
❑
Farrow to Feeder
❑
Farrow to Finish
❑Gilts
❑
Boars
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Doi
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge'observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes L2 No ❑ NA ❑ NE
❑Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Q4o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 3 — Date of Inspection 5 t)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes L+1No
❑ 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: Lh CCIJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 442.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ffNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes dNo
❑ 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 o ❑ 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 E2 No ❑ NA ❑ NE
maintenance/improvement? ,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ED/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:5/No
❑ NA
❑ NE
.�� ..$.:].. id � -. r i'13 d: e'. :ik:t�i
Co-s----- Xntsa(refer to gpestion}}#) Ey,xp�lain any YES answers and/xohrtany recpomWymendationsior°any other comments �I Jjy[-4 1s
�ry x,8.k.S:. -1 2• k8�. .. X..'� #�h.l ,f: �..5[R it (-Qt/:Ji.,,:.. li P, f t
Use;drawm s`of+facile tol6etterex la�m's�tuations. use+add1tionai a esasnecessary,.,
�1. +alit, pz.s.:„ilt4liI�,iis;+tttt�.x;fA����$.i�r � ���� ���d;>;14,.��d
Reviewer/inspector Name a 1- } r. Phone:
Reviewer/Inspector Signature: Date: 5
Page 2 of 3 1 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
No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists g ❑ Maps ❑ Other ❑ Desi n
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElEN Yes
,_.,,�
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain Inspections❑
Weather
Code
22,
Did the facility fail to install and maintain a rain gauge?
El Yes
[ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dTN,10
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
�/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�o
❑ 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
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 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
Rio
❑ 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
C;No
❑ NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P< IN
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
t' No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit Q/Routlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: to 3o Arrival Time: ® Departure Time: County: Region:
Farm Name: I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ` Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = Longitude: = ° = I =
di
FMH
Design Current
Design Current
Design Current
Swine C►apacity Popu�ation
Wet Poultry Capacity Population
C*attle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
on -Layer
❑ Dair Calf
❑ Feeder to Finish
airV Heifer
® Farrow to Wean 1
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stacker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Ko
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

'r
Facility Number: 31 — `0 Date of Inspection 30
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes L/J 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: LAQ70/V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-8
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 LJ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 V(No ❑ 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 ENo ❑ 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
fo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
Zo
❑ 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?
El Yes
, �/
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
7No
❑ NA
❑ NE
9,(.,) 9AUG_ 0Vc CATtLD A r;SA13k-�
Reviewer/Inspector Name ftt ; p' e�,.;�'j 4 lea�_r,.,t;,`„ Phone: �1I�
Reviewer/Inspector Signature ,k, _ Date: 1 d 30o
17/7R/RQ Cna�isrr�ad

Facility Number: 31 — S Date of Inspection b o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi n ❑ Ma s ❑Other
g p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[Z/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O'l o
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
FJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[f Yes
[No
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
,:1
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z o
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
I 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
M 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
❑ NA
[INE
General permit? (ie/ discharge, freeboard problems, over application)
7N9
32.
33.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Does facility require a follow-up visit by same agency?
❑ Yes❑
NA
❑ NE
El Yes
No
❑ NA
❑ NE
12128104

Type of Visit 6 Co70utlne
liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5� Arrival Time: ® Departure Time: �.J County: QV PLl� Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: KExm4 siza Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = d = Longitude: = 0 0 , =
41
Destgn Current ^ Design; Gurrenf ` 4i }.F'Design. {Cterrent #°
Swine; iCapacity Population Wet Poultry ,.Capacity Population Cattle' ty Cap acttyPop'ulation.
I
� ❑ Layer a
,< ; , ❑ Non -Layer t
I
�xJ, $.m Yz �a + t `•If .' a fit+
1100 �xDry=Poultry„r
�s
' `r
Others t � t � , #..:Turkey
z ._ C.%_�. t,.x�
❑ Other # A. umber.o�if�Structures
�i .•��;`.�tkl. ±k�, i:::eti� cif±VS. �i,$S,F �. y: SkeAs�, a� -yi :€: 4�s .E ' !$t. a�'Rs �. saat.F�P.$eTPMi.:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
b 0
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Moults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges &Stream Impacts
JNo
1. is any discharge observed from any part of the operation?
❑Yes
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑Yes
�
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/t?4
Continued

Facility ]Number: 3 —gb Date of Inspection Y o
Waste_Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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
[YNo
❑ 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 thr at, 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
ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
,.,�
l/ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1/No
❑ NA ❑ NE
maintenance/improvement?
WNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ 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
C7f
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,[.No
11J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
Vo
[INA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ NA
❑ NE
er to question #): Explain any YES answers and/or any recommendations or any other comments.
11molf facility tobetter explain situations. (use additional pages as necessary):
w
n
Reviewer/InsP ector Name xx�# xs � ;fix ; .�. ):� Gv' T e� :, " lx U� Phone: 7 W
I #.s106
Reviewer/Inspector Signature: 2Z Date: O
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection
iteguired 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 LI No ❑ 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 �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections
//❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes 2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I , o ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J I No A
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No ��A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
,�,�
IJ No
[3NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes Yes
❑ 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
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ N
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

t�
Facility Number 3 $65
UrDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Vislt 7Routine
pllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Qther ❑ Denied Access
Date of Visit: �t t'i p-) Arrival Time: 3t7 Departure Time: County: ��t Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: V. U114 9A2 & 1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= d 014 Longitude: = 0 0 d 0
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry i Capacity Population Cattle Capacity Population
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke Poults
❑ Other
Discharges & Stream Imeacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Daia Cow.
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structurm
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?
El Yes 12No El NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E No ❑ NA ❑ NE
❑ Yes L7No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — S Date of Inspection �, 6
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes DNo ❑ 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: LAGoo JJ
Spillway?:
Designed Freeboard (in): lot S
Observed Freeboard (in): 44
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[2rNo
❑ 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
0"No
ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? El2 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 El Yes
,�,/
LJ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement'?
t I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,_,/
IJ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E,rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
LeiNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
914
❑ 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):
T
Reviewer/Inspector Name vphl�J Phone 6 - Y,?
Reviewer/Inspector Signature: Date: 91t2lo
12128104 Continued

Facility Number: 31 —Say Date of Inspection ct U7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes r_ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections
El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
eNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
D'go
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2-f-4o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LAVA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the hermit or CAWMP? ❑ Yes CTNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ'Iqo
❑ 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
12-<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El,�—
Yes
-,,�
Ld'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
E3<o
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
❑Yes
,_.
No
❑ NA
❑ NE
al Comments and/or Drawings:
12128104

ki
Type of Visit ^ompiiance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
(
Reason for Visit ,RouL/tine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: P7 !X/` Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 Title:
6
On site Representative: ��yly dAz&&
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` = Longitude: = ° ❑ ` = "
Design Current
Swine ��Oava:cit—vzPopulation
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 7 b
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Current
ENEC.,4..'Reit,P.opulati_on
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design C•nrrent
C►attle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
/
1. Is any discharge observed from any part of the operation?
El Yes
I,�„(w�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
No
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
,❑
NN
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
LQ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:
Date of Inspection b oG
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: 4AC,Sols1_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
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 U No ❑ NA ❑ NE
❑ Yes hfo ❑ 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 /❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P, ❑ 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 ❑ Df6 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [;*o ❑ NA ❑ NE
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) (� � S G 0
13. Soil type(s) L.'�NGNem<_ ..__
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VN
EEl NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 'Z/T o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes XNo ❑ 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):
LPAATe 1JUP Few AU, +3Ca2,►+^�R �`rL`(aC OS
Reviewer/Inspector Name I - �Ja - -- — — - - - Phone: _ q 6 2379
Reviewer/Inspector Signature: Date:-leALZ
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection d L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes n No ❑ NA ❑ NE
20. Does the facility fail to ha;e�
ents of the CAWMP readily available? If yes, check es El No [I NA ❑ NE
the appropriate box. Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ETNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L31N'o
❑ NA ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El2 yes
--
o
❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Flo
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�_, o
❑ 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?
El Yes
El No
A ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
`tom o ❑ 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?
El Yes
�
E?<o ❑ 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
BNo ❑ 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
❑'R10 ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2No ❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit P Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit P Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: s //a}} O Arrival Time:
G ; Departure Time: County: t- , Region:O
Farm Name: tYls 1�Odc /Qd1 �F ,Or�Pez.J,_ G. Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: i�2 � Ax
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Phone No:
Integrator: _ . L,<fZ)i /,,
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ i Longitude: ❑ o = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
h0 Non -La et
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: i
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 Slate
other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ 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 ►h
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes PfNo ❑ 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 _01 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes / No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidencq of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
IN
r
914�
13. Soil type(s) /Vif_ to
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,IJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes VNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes )eNo ❑ NA ❑ NE
21) L
A-rf_s�r �o�G F�e� /7Iq / i��2l�s� fUoy �€ f1�Efl/1A�� 5 ���
/4-1;f2 L5a�L
-/� y`--�i�cfy�-,o,, JYF CO�a�..s✓G� `�/°,� ,✓t �iUo ���2 �,���-�. J�i»�'� ��
. ;.
Reviewer/Inspector Name � `: �' '.`;. `� ,w , y �„�., � �.� �;: + Phone. 40'
Reviewer/Inspector Signature: Date: 11,19
12128104 Continued

Facility Number: — rf Date of Inspection /d O
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 jo Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP P Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;n No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�3 No
❑ 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
VrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X,No
[I NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
VNo
❑ NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V No
❑ NA
❑ NE
Additional Goiiients'andlor•Drawitgs . ..}'
�I �! d GJ�z 7f aui.✓ O�/y�� 71327�.�� // r� 5
13--15) 7q,3 AAW,
GoSa�✓�
I�j ©ILG�N2T�.lJ f�77<,Q /IizNz�'i��S %!ff_ /TzS�f' Qi
eo '1"'0 LJ/i
r
o s y.,i.Bf�n�UO A %f y0�s T
6G AM ;P4 kraao� Ale -I., &A�,
12128104

Type of Visit 2FCompliance Inspection O Operation Review O Lagoon Evaluation 1
Reason for Visit JO Routine O Complaint p Follow up p Emergency Notification O Other Cl Denied Access
Facility Number Date of Visit: (. Q Time:
Q Not Operational Q Below Threshold
Permitted )ZCertified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: ....... DA....... GR9�.P ..... P.-JM........................................................ County: ». l l.......................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
MailingAddress: ... .................. .................................................... .......................................... ........................................................................ ........ ..........................
FacilityContact: ........................................... ............................. Title:.......................................................... Phone No:...................................................
OnsiteRepresentative: ... ....... ..t-l!................................................. Integrator:...........!=li..........................................
Certified Operator: ................................................... ........ . ................................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude 4 44
t j DeSlgn��F�F.iC1lrCent�' ,fit' ifF t �Y DeSjIIE I� CElrrent€€. Y S xE , F (�DeSlil
Sw1iie °i E ; Ca aA 'Po ulation , Poultry ; 4, Ca' aei Po' ulahoinli `Caere ,�' Ca ace
❑ Wean to Feeder
❑Layer
s(❑Dairy
❑ Feeder to Finish
i,',l
❑ Non -Layer
I
Non -Dairy
Farrow to Wean
Q
1, , ❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish
Fa�Jrr
' jj ff:t u�i s• n ,x+ i�f *�3 cSC:t } E �! ' +-li� �� A
6�Yil{i�ek �tF E f.73.,4➢ I t F �, i , 3.� 1 iSUI� 6E 1,l'
Total Deslgn,capacl.ty,
❑ Gilts,
❑ Boars
•iE,...st_ 4.•__x _.x ':e f .) ..E .. I...
Discharges & Stream ImRaaets
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 gaUmin?
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
Id t' i"ier
❑ Yes Zo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 7No
❑ Yes
❑ Yes �o
Structure b
cn.................................................................................................................................................................................... I.......................
Freeboard (inches):
12112103 Continued

Facility Number: 31 — 05• Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yesj`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 �To
& Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 7NO
f
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 010
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ` 0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Sj ee mL A (M 5G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
j�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[ 0
b) Does the facility need a wettable acre determination?
❑ Yes
["No
c) This facility is pended for a wettable acre determination?
❑ Yes
[ 1No
15.
Does the receiving crop need improvement?
[Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
L.7 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
12<o
liquid level of lagoon or storage pond with no agitation?
18,
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
19.
Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
WNo
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
UINo
Air Quality representative immediately.
!. e: .:t i+:,.t'"4T°F,, • f': ..:i .:�.,.+ S. 't .,. .. ri.ltHEe:¢3fte@t'.dyr..3PtC} :#tr.'eF�li',.7a.::Yfs.a .!.,
iCommepts (ref& to question #) #?Up1Wii ifi*YES�3answers ant}/orrany recommeadaUons orla y'other co r =`F' � f 1 ,
' r -t. € 7 - i, 11 r
d d.;N..�? ";'OVA' M s - aF'4'rt - #
tiE uc r r. .:, s �i„i.; r€ t . 1t ; 7 .•
€Use drawtngs offacihty}to bet[telr explah�nFsttuateons (userbdditzoaal pages as a�essary) `[] Field Copy Final Notes fr
,o t A },. - l F is}.fe
..E-..fi.nfc➢P¢( i ';A3i - llkiS{3. � F t t f • rf t iy Il d3s�
tuu''��..�.,pt
t'}}, .�: t0�3 ;F � ,it ?Ldd F a .'.efl� Pf tP e�'`.�a � fd Oi t ft;
d;,_4�.. >z - d ¢ L:tt. y.. _ q( <. , Ff ff it q? F p 13j�:` 9 }-r 3 j d71Eit t' tagtf6i F)>;. €Eai!�q. ..f,..¢ ?:w fir• r3 _}:& .per; 3" rrt}��}y�°-'r`mf nm`; RR�"r�n'f q'I .I �. s
ffi.vW4�, Cn�il�Ji".__._.1.__..,-..ik'ciFs'_..-_,�..- rt�,c_.. _..�¢- 4.N .. ....v::'�{; .� t[.F'E'.-�n1�._L .e...
rJG6�b CoNT"G OF WILD GRASS, J�An KEM PL"6 Td
5eRfl'? LAT6r� -r1415
•
Reviewer/Inspector ector Name ��j1>r"r`' fi z
H �± � §'�
p ..: , .¢s f;F lr�t. /u . ; d 3 r ; 'J'
Reviewer/Inspector Signature: Date: a
12112103 1 Continued

Facility Number: 3 — s Date of Inspection
'Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [:]Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes aNl o
❑ Yes VNo
❑ Yes
❑ Yes [�
❑ Yes No
❑ Yes 2 N c
❑ Yes
❑ Yes 7No
❑ Yes 0No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review [Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: �F=NotOT'erational
me: . Q 0 Below Threshold
0 Permitted 0 /Ceertlfi d r0 Conditionally Certified 0 Registered Date Last Operated or Above Th eshold:
Farm Name: L/ U' re V`_4k_ County:
Owner Name: Q f A,t rPhone No:
Mailing Address:
'T �
Facility Contact: v U Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
ET Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� i�°° Longitude
Design Current Design Current Design Current
Swine Capacity Population P ultry Capacity Population Cattle Caloacitv Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairyi
ElF der to Finish ❑ Non -Layer ❑ Non-Dai f
.2'Farrow to Wean
El
Farrow to Feeder❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
F1 Boars Total SSLW I
='Number of Lagoons �!. ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ra Field Area
_ _
Holding Pentls 1 Solitl Traps I❑ stem No Liquid Waste Management S
Discharggs & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Ycs�_,❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No '
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Stnieture 6
Identifier:
Freeboard (inches):
05103101 Continued

acility Number:`' Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health: or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ARplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DW'Q of emergency situations as required by General Permit?
(ie% discharge. freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about tlib visit.
A f 3'9 Ae6
Comments (refer to qu3}4estion plain.any,YES answers,atidlar arty reearu�rct�ntiatsotisFar �tty at1t� �mments Y��E
Use drawinj s`of facllity, to better e=plain slttiattons, (use additional pages as necessary) N o: ❑Field Copy ❑Final Notes >,
,
V� i P ,us Et K g.i ;: �"� ;rt k :R n k lI � i due} zY wwLL ° fx ,+ c E Xku.oSiC§T+a�kdi N6°re�.N'a"!�hC"�"Jna+'�i+�+�Wt+'3°^e.+w[ww�cs�r."-'3
I dw a
4�'ryr o
Reviewer/Inspector Name x s
,. ..: , �.
Reviewer/Inspector Signature: 4 Date:
05103101 { f Continued

Type of Visit 97 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not O erational OBelowThreshold
16 Permitted 13C ified 0 Conditionally tified 0 Registeeed A,Daa�te Last Operate r Above Threshold:
Farm Name: �`'v County: �ayLAN
Owner Name: L �� rho d . Phone No:
Mailing Address:
Facility Contact:
Onsite Represental
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` 0 �6 Longitude ' «
Design Current Design Current Design. Current
Swine Capacity Population P ultry Capacity Population Cattle Capacltv Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
ElFeeder to Finish ❑ Non -La er ❑ Non -Dal
E]
Farrow to Wean qj9PT
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
1 NAr iAfier of Lagooris Q ' ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
i / Solid Traps °ilk I 10 No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Frecboard (inches):
OS/03101
❑ Yes Q�No
El Yes (❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
/�No
El Yes XNo
❑ Yes No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ yes
INO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
Immediate public health or environmental threat, notify DWQ)
�(
7. Do any of the structures need maintenance/improvement?
❑ Yes
JLJ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
INo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
/
elevation markings?
❑ Yes
#No
WastepRlication
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
A
11. Is there evidence of over applicatio ? ❑ Excessive Ponding PAN ❑ ydraulic Overload
❑ Yes
YNO
12. Crop type �&)
13. Do the receiving crops differ with ose designated in the Certified Animal Waste anagement Plan CAWMP)?
❑ Yes
9TNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ONo
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?
ElYes
ONo
Rellred RecordDocuments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
VNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
,� No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
%No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes]
No
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
/Ar
24. Does facility require a follow-up visit by same agency?
❑Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to questWWW" `Explain any YES answers d u a eriy recoinmendatjans r any ter
Use drawings ;ofifacility to.better explain situations usee f ddittional pages as necessary) , Field Co ❑ Final
x ❑ Final N�
AV
0
> 4; nj
��G.S�i✓�C ����f}GZs ; L
,�/ �� % ` G(���P
�Ffs� ��i►� �G�'/ram
u
Reviewer/Inspector Name x f% r "
A
y �" '�
Reviewer/Inspector Signature: 4
Date: 3 ,PZ
05103101 Continued

Facility Number: — Date of Inspection 0
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
❑ Yes L��yfflV0
El Yes � o
❑ Yes [; No
❑ Yes Pr-1
0
El Yeso
❑ Yes No
Additional Comments and/or Drawings:,,,` k"A'T 4
b -SF_� ,E7?F Fy7/ i 2rJl p dF_�L
�asyor
J
l
r�
l8 D �c2
�A/
05103101

[Type of Visit compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 'PlAoutine O Complaint O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number 3 Date of Visit:
0 Permitted 0 Certifi�e+d 13 Conditionally Certified 0 Registered
Farm Name: .... �a.k/..t?!....ot,.'.r5af°4t:.o...DU(fl`�..�.. !�`r.'..........
Owner Name:..........4e t'!.....F1�tl.d''........................................................................
Time:
10 Not Operational O Below Threshold I
Date Last Operated or Above Threshold: .........................
County: .o�!.'..!:..........................................................
PhoneNo:...................................................................................:.
FacilityContact:............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress:...............I...................................................................../.�..................................................................................................r................... ....,.........................
Onsite Representative:..) e.1 Q!'r!r ... Co.e-M),....�.;,1.°Or.'e................ integrator: rC ?. c.'.• '� �....1..L Qri�t:1.......................
Certified Operator: .........................
Location of Farm:
Operator Certification Number:....... ...................................
,EfSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • 4 «
Design Current Design . Curre�ut' Design CaiTeat
Swipe ::. ,",: _.Cis aci v Population Poultry „ Capacity...Po Population Cattle ,Ca aci Po ulafion,"�
....-..-
❑Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer 1 10 Non -Dairy
arrow to Wean 1,760Nr
❑Other " tit ,
❑ Farrow to Feeder
❑ Farrow to Finish Total Design Cap>;dty". 17
�..� ❑Gilts s i ... •.
❑ Boars `Total "S�Lw"'.
Nuinber;of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area . ❑ Spray Field Area
,Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
J 4.E,.
Discharges & Stream Impaet4
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
�Stfructure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:.....!.�1.e.�3�................G"!'.......................................................................................................
Freeboard (inches):
S/OD
❑ Yes 'VNo
❑ Yes �No
❑ Yes /,EfNo
17
❑ Yes �No
❑ Yes/5No
❑ Yes PNo
❑ Yes/jdNo
Structure 6
Confinued on back

Facility Number: _?— 5 I Date of Inspection l D ,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IONo
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)
%. 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 ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 11110
v ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload Yes ?1110
11. Is there evidence of over application? ❑
12. Crop type Oeren.v44 e,Smn 4,^ ,"
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 0
b) Does the facility need a wettable acre determination?
❑ Yes / No
c) This facility is pended for a wettable acre determination?
❑ Ye No
15.
Does the receiving crop need improvement?
❑ Yes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes/,11No
Required Records &Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes/,11No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ YesNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
/P110
❑ Yes [�'1Vo
21.
Did the facility fail to have a actively certified operator in charge?
❑ YesNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ;3110
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes �dNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes ETo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes )3"No
�ciQ yiQl�iit}gs ot, 0,04c' xeoei" w'vre ratted• Oolog NsAsit; • Y:oo wiii-tooiye 40 f'uttbo . .
coriesb6fideRce: abouC this visit. :................:.................. .

Facility Nuniber: 3 j — Q Date of Inspection
Odor tissues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes.�o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ;�`No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 1'No4
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J2
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5/00

0Division of Water Quality.
' � .F
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number G Date of Visit: -GV Time: ® Printed on: 7/21/2000
Q Not O erational Q Below Threshold
10'Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: t,�L�I��C...GW County:....... 1,t..........................................................
... t''1......
OwnerName:•..................................................................
Phone No:
FacilityContact:..............................................................................'1'itle:...................................................... Phone No:
MailingAddress: ........................✓...................................O.....�...........I........I..........
...................................................,..................
.........
� ...................................................................
r 1 ,
Onsite Representative.. �LN.............@!^....`Interator:.....� �.....................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
I�
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� ��� Longitude • �� I
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacitv Po ulation Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
❑ Feeder to Finish ❑Non -Layer ❑ Non -Dairy
Farrow to Wean (}p
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Uipon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream imuactti
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? (II'yes, notify DWQ)
c. If discharge is observed. what is [lie estimated Ilow in gal/inin?
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
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �rNo
❑ Yes 0 No
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes allo
StrUC[Ure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:..............................................................................................................
Freeboard (inches):
5100 Continued on back

Facility -Number: 3 G Date of .Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste_ Appi anon
10. Are there any buffers that need maintenance/improvement'? ❑ Yes 9No
11. Is there evidence of over application? [:]Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Yes r7,(No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, checklists, design, maps, etc.)
19. Does -record keeping need improvement'? (ic/ irrigation, freehoard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
oie�Ryafigris:oi dgfcrces mere ngte d rFnthis;visit0Y1. e fio furtpe. :
corres' orideirce: about: this visit
❑ Yes 'W'No
❑ Yes �jf No
❑ Yes ❑ No
❑ Yes ❑ No
KYes ❑ No
❑ Yes $No
❑ Yes 9No
❑ Yes ,KNo
❑ Yes KNo
❑ Yes ONO
[:]Yes P(No
❑ Yes VNo
❑ Yes ONO
❑ Yes tKNo
❑ Yes gNo
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): rr
z� e Vw4G t j
Reviewer/Inspector Name 1 Q`Q 9(0 —3 t S 3 f o o hi ,-,)gc
Reviewer/Inspector Signature: Date: i(G—( k 0 $/00

Facility Number: -gC Date of Inspection Ct- GG I'Anted on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor bielow ❑ Yes 19No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes NYNo
rT
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) []Yes J�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,�rNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Pilo
Additional Comments and/orDrawings:
j
.
S�
P--V e- - V�\Ze_& "r, G-V4IJIC
V3
k A-- �O
�
� 1
5100

C Division of Soil and Water Con§ervation-bper'ation RcAdw � 't
0 Division of Soil and Water Conservation - Compliance Inspection r
Division of ;Water' unlit Corti Iiance.Ins ec'tion
t ` ©Othei 'Agcitcy w -Operation -Revie
vi .
JQ Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review • Q Other
Facility Number 3 Date of Inspection 2
1 'Pint: oi' Inspection 24 hr. (hh:mm)
�] Permitted Certified © Conditionally Certified ❑ Registered 0 Not O erational Date Last Operated:
ry� T-�-�� ..........................
Farm Name: � rK �1aD lz,an o!= Pu Pq,/J 6 County:...................eL�'r'.`!............................................. u....... f�........................................................ -t...`............... `) ... ..1
Owner Name: ►t..........i'................................................... Phnue No:.....,1.....Y..../...1...�i.................................
.................. '
FacilityContact:..............................................................................Title:................................................... ..... Phone No:
Mailing Address: d CLF+'rP l'11 �GLAGc.'...... r..C...........Z
1....................................................................................................................
Onsite Representative: ��.t.f,i'L { �.Y.tr..... �. 1 .....�},��1.. .. Integrator: ....... D-?-J...........................................................
Certified Operator: "tP T '..........V. �t12- .............. Operator Certification Number:..........................................
.......... ......
Location of Farrn:
........................... D.n.....M .... ....... vok ....... Qk ......... mt. ..tra4.}... d:... 3... .t► dA.5........rx.5j......af ...... ........................ I............ �
.......
Latitude �•�� ��� Longitude �• �° ��
Swine _ Capacity Population Poultry Capacity Population Cattle Capacity Population.
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity -700
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Disc:har.ges & Stream Impact�5
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ruan-made?
b. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharce is observed, what is the estimated flow in gal/ruin'?
d. Does discharge bypass a lagoon syslem?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than frorn a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3
ldcntifier; 00 Ne0
Freeboard (inches): ............. I................... 2g
Structure 4 Struclure 5
❑ Yes [% No
❑ Yes [ No
❑ Yes No
❑ Yes P No
❑ Yes fp No
❑ Yes M No
❑ Yes 4 No
Structure 6
1/6/99 Continued on back

Facility Number: 3 -- Date of Inspection ! Si
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, El Yes ®No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? 0 Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ® Yes ❑ No
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
® Yes
❑ No
Waste Application
10. Arc there any buffers that need maintenance/impr()vcnicnt?
❑ Yes
No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑Yes
No
12. Crop type .............. hArw..&................ 5.!! c........ G.Y.A!.s1.......... .................. ......................................................................................................................
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
(4No
14. Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
19 No
15. Does the receiving crop need improvement'?
09 Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
V,No
RC Hired .Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
0 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, [naps, etc.)
❑ Yes
A] No
19. Does record keeping need improvement'? (ie/ irrigation, Freeboard, waste analysis & soil sample reports)
❑ Yes
No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
j No
21. Did the facility fail to haven certified operator in responsible charge?
❑ Yes
ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
,�q
C6 No
(ie/ discharge, freeboard problems, over application)
❑ Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
No:viafations-or. deficiencies :were rio:IEd: during :tfiis:visit:: I'.ou will're[ceive n� r tribe'- : :
eorresP6iidence' about: this visit.::::: :::::::::: :..: .... ... • • • .:...: * . .
Comments (refer to question #): Explain any YES answers and/or any, recommendations or any. other comments.,
ra
"Wings
of facility, to -better explain situations. (use additional pages as necessary): t bse j;•
n1) ro ri t. ¢Qrrlu ry • ���iV 1'{ovJ}Or- Wi �
�11Q ltr �J�tNL �p.S tocct- C�Ir(��f.R'1UI,11
�n11of1�%u'r ekaStol� Orca� or OUCHf VtK� Gitti�� �t�SPS Fr. 140.raDr\ SNscJlu Wes- M Ve
q. 60 1�140r, doss qo' kof
Is, Sn�l1 ��air �hou�c� be ,t�''rovc�,
Reviewer/Inspector Name ,
Reviewer/Inspector Signature:
Date:
1/6/99

n,�,rn to Con erM..Mw,w
k Divisio of Soii and Wa s nation Qther Agency
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
EFacility Number U
Time of Inspection 6G 24 hr. (hh:mm)
0 Registered [3 Certified 0 Applied for Permit CNPermitted 113 Not Operational Date Last Operated:
..........................
FarmName:.................`e....................................,.................... County: .... A.\ ................................... .......................
OwnerName:............I ............. �'............................................................................. Phone No:...............................................................G— 5t..l`....... .
'
Facilit Contact Title Phone No, Sj 4 F
Mailing Address: „bf r`1.... .1 ... c"' p....`..�:'!........... 1 ��,.. ... dam'Lb�.................................................... .................. I.......
Onsite Representative:... Q`.1............................ Integrator:... .... �-! n. ...................
Certified Operator;............................................................................................................... Operator Certification Number;..................
Locatio of F rm:
..................:.....WFA
S ............. ....... .............. .......................,.r........... ........ .......!-, ........................
1
..�s..a..f�..'...-;4..,....p.............111.........9................................................................................................................ .
Latitude =' 0' 0" Longitude ' Os =11
Design Current
'. pDesign Current, ,, ;:
J Design „ .;,Current„
Capacity'°'Population
Pauitry Capacity "Population Cattle
Capacity Papulaton,f,;
r
.Wean _.n
❑ to Feeder
a
--I[]
Layer'
❑ Dairy
moo,
❑Feeder to Finish
❑ Non -Layer
•,
❑ Non -Dairy
Farrow to Wean
'`jOU
y'
❑ Farrow to Feeder
❑Other
"
a TOW Design;Capt�d y
...
[Ix.
Farrow to Finish
A
❑ Gilts,-
�
�` x� ��° �,,� �, T Dial SS LW
Boars
;. _...
Number of Lsgt�ons#! Holding Ponds ® ❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
r
No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes P1No
2. Is any discharge observed from any part of the operation? ❑ Yes j(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONO
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flow in gal/min? 1 ^N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19 No
3. Is there evidence of past discharge from any part of the operation? ElYes [XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes allo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes NJ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes allo
7/25/97

Facility Number: — OV6S
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds Flush Pits etc,
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structu e 1 Stnic ❑re 2 Structure 3
Identifier:.
...................................
Freeboard (f't).............P:...�1...................................................
10. Is seepage observed from any of the structures?
Yes ❑ No
❑ Yes UNo
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum'liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP or runoff entering waters of the State, notify DWQ)
15. Crop type � ^ _ ..........................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0- No.violations-oc de iciencies: were noted-dur'ing this"visit.- :You,wiil ireceive'-no-iu:riher- ; -
c6er6o6ndeike dtiout this:visit:- ::.: , . :: : ; ,. , .. .. ' . `. ' .
❑ Yes RNo
❑ Yes W No
12�yes ❑ No
t,Yes [:jNo
❑ Yes gNo
❑ Yes (KNo
❑ Yes 5jNo
.Yes ❑ No
❑ Yes % No
❑ Yes ff No
❑ Yes IgNo
(JYes ❑ No
❑ Yes �f No
❑ Yes ONo
❑ Yes KNo
kokycv-,
It~ o lJ 11--
�_4 � 1 1
I�S � /44 ►-, � As 't►-- 5�� eS j� f �_ lr L .�iw�.Ie �- (5� '(ln j' �t�yo. eye �t eldy, �.1c C.
j�@'d iF�� c^.-/ l ti S�Q 1�C} '!-s�l.���L►'e. G� . ��1i"`Q
lse5t� +fie 2tc� w�j Gam` �, e� wis �S j�rr�+-tab �y �v 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 11 3 L171V

EHeility Number: —.. Q..... Date of Inspection:
Additional Comments and/or Drawings: ` Y,
d
CA 1'�r��^���� AAA•+
�� c ✓ k'lrL" \ Cy0 r VC) \� G+'� fi.+� `J ` ti c�i jp�/V2ir-z
Oar c�'T S4 �s ,�Pe1. 1r �lafeit 44k
�r
vl--Vk
111
De0^ �\Uh
DWGL
��Kas 3�yS
(Y ao�]
4/30/97

.EIDSWC Animal Feedlot Operation Review
-�DWQ Animal Feedlot Operation Site Inspection y ;
Ituutitte OComplaint I allow-u aT t)N1'f ins cxtitrn OFollow-up f DSWC review 0Othero
FMCO(
f InspectionFacility Number
T Inspection ' 3� 24 hr. (hh:mm)
13 Registered 0 Certified (3 Applied for Permit Pt
Permitted 1E3 Not Operational Date Last Operated:
FarmName: ...... 0�.K...... i.kc.,.,ge...... 6m.......................................... County: b4,?`'A ....................................... ..................
UFvncrName:...... �.f.-,r,....,r......................................................................... Phone No: ...
/...............................................
Facility Contact: ....1 h`..... i�t44................... ......... Title:... 0W)..%#jr................. ... Phone No: 4�.��0 z1....64,15..........
MailingAddress:..-Le.LN 01) ..till........................................................ ... 0.0.1dtz... t....4L................................................ zk#6.6...
Onsite Representative: .... Kt.i. ..................................................................... Intcgrator:...D%,,..' ............ ..........................
4rC........................................................................ Operator Certification Numbers....f.I �......................
Certified Operator;.... ►t.t' �....4 �1�
Location of Farm:
r� ...... �...........Sn,....... txa.........a.L.�te.......l.t�r.r`...:�t . . .....Gn....S} ..L�. ........f�Ym... t.s...... iS: ...Y.hx.if.... ic.....sR.........
......D.h....:r►cIt"tl-,�e�L ...�►rt.:................................................................................................................................................................................................ .
Latitude `1 6C Longitude • �44
Current
Swine Capacity
❑ Wean to Feeder
❑ Feeder to Finish
a, Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons /Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'?
❑ Yes
Callo
2. Is any discharge observed from any part of the operation?
❑ Yes
M No
DI -chime ori�-inated at: ❑ Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
1@ No
b. If dischar-c is observed, did it reach Surface Water'? 01'ves, notify DWQ)
[]Yes
9No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon systern? (If yes, notify DWQ)
❑ Yes
19 No
3. Is there evidence of past discharge from any part of the operation'?
❑ Yes
D9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
R No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
® Yes
❑ No
mai n ten ance/i mp rove me nt?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(3 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
IQ No
7/25/97
Continued
on back

,. Facili'ty Number: 31 — gpy
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Yes
(9No
Structures tLaeouns,Iloldinu Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
D"No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: fJ�.l.............................!?...........................................,.....,.......................................................................
...............
...................................
Freeboard(ft): .... .....:....................... 10................. .............................. ......................................... .................................... ....................................
10. Is seepage observed from any of the structures'?
❑ Yes
krNo
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
,Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
B. Do any of the structures lack adequate minimum or maximum liquid level markers?
Yes
❑ No
Waste Application
14. Is there physical evidence of over application'?
❑ Yes
F�[ No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............b9mmuAA............................................................................................. ........................... .......................
...........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application`?
❑ Yes
No
18.
Does the receiving crop need improvement?
N Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
[N No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspec`tor fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
CO No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
®,No
® No.violations,or deficiencies were noted during this.visit.- Yott.rvill receive no further
correspondence ah'out this:visif.... .:. .:......
Comments' (refer to question #) ;Explain any YES answers and/or any recommendations or" any, oilier commtsenI r
Use drawings of facility to better explain situations. (use additional page"sr. MWI
S 1rngAht�. sy^,, nod InS41W - Plav►rue} .6 b" tr, by Der,.I J9�7.
$• 01jayor 6A si F t. rUta c Asc ov?14n . Carjac{_� Sol f 4- Mt6 D1 a�rick 4_ CSS is �Mce.
IZ . (&»s ghou)0 6 ntwey . %arU c► us on ' U raw lga�por• SiacxJ1r} 6e, (esep_der}. &Yosi
6-rfas N7 tnLeiaC Skov� 6e, 4f W Wiµ. G� t4 tesQ�fi,
13. 013 106 Acn 3Ot5Y1 i 0."X V046-C r,
IS_ &4_N && c.yop Shwb be zrrplro4. a. s61* wash 4 tv -akevO �e �{�t(CtK. Irsrcf ar.� JOI cA01 ewJ tyi0 h" dz'poral INh
shet�l� 4 Zn rtan•-ioL l riser hum6t-s iK S?y1j afork. 7/25/97
Reviewer/Inspector Namev'
Reviewer/Inspector Signature: A4A —__Z_ __ _ Date: I h 197