310060_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

O D�v�sian of Water ResaurcesR;�¢' ` �"
Fro
aciiity 1;Tuntber ;M 0 Division=of Soil and WaterCanservahan y= ,
a . s
r g
_. _. .0 Other.A ency
Type of Visit: 0 rRoutine
liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
isit:Reason for V0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: n I
O nsite Representative: (1,, A- t l't 1 4-,� L-k V 1Aw a' Yet p 5
Certified Operator:
Bach -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 12 '�_ ?/tl
Certification Number:
Longitude:
-
Cu --^` DCSI n "Crent s�-
a'.'t
Design Current g rDe"sign @urrent..
Swine Capacity Pop,Wet�Poultry Capacity Pop "Gat le ;Capacity Pop
eanto Finish
Wean to Feeder
ZA7
(r pi
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer a "
Non -La er
P
yy
Design Current"
M wD "Point GaT aci Po
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
ow
alf
eifer
F
wi
Beef Stocker
Beef Feeder
Beef Brood Cow
✓'�'y ���,M F' �� � a- �"sue
❑ Yes Z No ❑ NA ❑ NE
0 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)
❑ Yes
❑ N ❑ NA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
[]Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] YesVNo❑
NA
❑ NE
of the State other than from a discharge?
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 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 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 environmentaljbreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 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 No ❑ NA ONE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Oo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [:]No ❑ NA'
❑ 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 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes El -No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [—]Yes o
❑ NA ONE
18. Is there a lack of properly operating waste application equipment? [—]Yes N'No ❑ NA ❑ NE
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 [r jN;"`D NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA E
❑ 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?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Er
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes��NoD 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 0-1l ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No A ❑ 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 No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
No ❑ NA ❑ NE
?NO--,[]
❑ NA ❑ NE
NA ❑ NE
ncvIcwc1iivaYc�w1 1V411[G. v . --- �I• I v 1 t Y' IV LAL t/ ruuur. i I—
Reviewer/Inspector Signature: ,---�( u'" Date: 1 ! 7
Page 3 of 3 21412015

W Division of Water Resources
Facility Number I� - © O Division of Soil and Water Conservation
O Other Agency
Type of Visit: pliance Inspection Operation Review p Structure Evaluation 'O Technical Assistance
Reason for Visit: Co(Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: (� Departure Time: ►I� County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (YIAQ S A ALI., A L L _S _
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: Z $ [
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder j i0
id
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Pon
Non-L
Pullets
Turke)
Poults
Design Current
Discharces 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?
Design Current
Capacity Pop.
DaiEy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA 0 NE
❑Yes
❑No
❑NA
❑NE
❑Yes
❑No
❑NA
❑NE
❑Yes ❑N ❑NA ❑NE
❑ Yes�/N0 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - 0 Date of Ins ection: S ;Z
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA [] NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: {�_ LA Gv d tr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� S
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 ZJ/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 environments hreat, 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 [ 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 E�/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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O/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):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q 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
El Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesFZ/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZT'
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
VN
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes . No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E60 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ 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 ENo [DNA ❑ NE
[—]Yes EJ/No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
❑ Yes
Comments (refer to question "#): Explain any YES answers and/or any, additional recommendations or other comments.
Use drawings of facility to bitter explain.situationsF(use.additionaa pages as necessary).
Wuca-T C P.o? (Az�(-_O fi. SSE ?AO oti ObLT co -of Rt>_Ta i t60j
Reviewer/Inspector Name: F R.ni CC ('
Reviewer/Inspector Signature:
Page 3 of 3
Phone: TI6) 6 d
Date: S (o
21412 J1 5

U Division of Water Resources
Facilsly Number �] - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
C
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: E= Departure Time:®® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: MFUZOPALA�- 'PUTLjZXJ
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
Phone:
Phone:
Integrator: o
Certification Number: Z 6
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
labbNon-La er
Layers
Non -La
Pullets
Other
Poults
Design Current
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ 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)
❑ Yes o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes Zo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El Yes WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facility Number: - Date of Inspection: 11
Waste C0)ection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10<0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Wr? LA &OW 1—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes i 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 environmen al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ['No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement.
1 L 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 Wo
❑ 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 YNo
❑ 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 �fNo
❑ 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 fNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [ o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes Wo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: Wil 11-15
24. Did t&-facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z-11,
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ 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 Z/NNo ❑ NA ❑ NE
❑ Yes 2f'No
❑ Yes �No
❑ Yes No
❑ Yes [V(o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitvto better exDlain situations (use additional Dages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone 10 16 f
Date:
214 015

G D Division of Water Quality
Facility Number ®- I �U J 0 Division of Soil and Water Conservation f N
E,
0 Other Agency
Type of Visit: C mpliance Inspection 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: FO�F Arrival Time: 1y= Departure Time: ® County: W��� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 08A 9-S rLL.-1rL
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 'j,bp
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Laver
Non-L
Pullets
Other
Poults
Design Current
_Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes CdNo ❑ NA ❑ NE
[-]Yes 2(No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

facility 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?
Structure ``1 Structure 2 Structure 3 Structure 4
Identifier: i,AC,—JN 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b D S
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
Structure 5
M/No ❑ NA ❑ NE
[:]No DNA ❑NE
Structure 6
[:]Yes No ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
d No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:)Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
U�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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 WYO
❑NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [o o
❑ 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 �
❑ 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 E(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. 6rYes ❑ No ❑ 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 Inspections
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CVo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Ds ection: rj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 WNNo
❑ 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
/ No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
0 Yes
E2r No
❑ NA
❑ NE
❑ Yes L=J Np ❑ NA ❑ NE
❑ Yes L!J o [DNA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
4160f O d f WA��E f on/ry � �1� N D a � , A � i,l GIEN �vtSt A� .
S1,C in
ul OGe C L"n,-_o APB(, Z411 , Au, tPH(WO NL F W,,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( '1117I ' M h `"
Date:
I

U' Division of Water .Quality
'Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 Arrival Time: ® Departure Time: ® County:DORM)_ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: M AftS WQc-&r�- i g LI,=-,PS Integrator:
Certified Operator: Certification Number: Zg
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Laver
Poults
Design . Current
Design, Current
Cattle Capacity . Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
I. 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)
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
o ❑ NA [3 NE
❑ Yes [ ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility_Number: Q Date of Inspection: % L P'k
Waste Collection & Treatment !
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 ❑ 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: LAG4Z$j I 1.ACxV>4 ?_-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �^C
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
M'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 i threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:I 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 E j o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3 xo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F!f 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
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
N
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
VNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " 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
13-4
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

FaciliNumber: Date of Inspection: �;2.
2.4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes RNo ❑ 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 dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ["No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: .
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
[] Yes Cf(No ❑ NA ❑ NE
❑ Yes [�< • ❑ NA ❑ NE
❑ Yes ✓ No ❑ NA ❑ NE
❑ Yes 1t1 1"0
❑ Yes [�o
❑ Yes ( No
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendations or any other.comments
Use drawidgs of facility to better explain situations (use additional pages as necessarv):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C 1 M9% `- 3 Df
Date: gjq 15
21412011

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
type of Visit: 7Routine
fiance Inspection Operation Review p Structure Evaluation O Technical Assistance
teason for Visit: O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: x �q,j 1 T Arrival Time: Departure Time: p rD County: L)LV(Z Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: MAWAMA ",r 7&r_ L,T Q1 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
"XlWean to Feeder 7,eb g5k
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Pnultry
Canaeity
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design, Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
D Cow
Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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)
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 ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
Page l of 3 214112011 Continued

Facili Number: - 66 jDate of Inspection: 7/
Waste Collection & Treatment
4. B,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E 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: LA6owiti LA(,oZW Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � o
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
[2/N/o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
OINo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ej4o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C�/No ❑ NA ❑ NE
❑ Excessive 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
Eo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
u N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
hlo
❑ 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
[ NNob
❑ 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
rZo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? []Yes 0"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facgity Number: 3 - Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ/No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Q 4o ❑ 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L No ❑ 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?
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.
❑ Yes ONo ❑ NA ❑ NE
[:)Yes No
❑ Yes CfNo
❑ NA ❑ NE
❑ 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 E31N,,
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any"additional recommendations or",any othercomments.�
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: VTc a rJ ap4 L�__
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �q! b) 2qG -73 q9
Date: 9 Z—
2✓412011

p� Division of Water Quality
FFaei7liNumber 0 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit ZRoutine
.pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: (L County: v W = t`' Region:
Farm Name:
Owner Nance:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M AKSI I,AiU
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
® Wean to Feeder
p
d�
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other ,
❑ Other �
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' [--] Longitude: [= ° = d
Design Current ;''Design rCurrent `
Wet Poultry Capacity Population Cattle `" 'Capacity Population°g
Layer
,
UNon-Layer
Dry Poultry .:
Pullets
Other
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
_,
Numbeiof Structures: -
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
ElNE
❑ Yes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — b
Date of inspection
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 1A 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: LA%bQ i L AP".,tJy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (4 Li Lt [
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 2No ❑ 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 th t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L�1 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 C No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EI No ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C�fo
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C, //o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ge't o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ll o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other comments
_y , .>� M:
Use drawings of facility;fo-better explain situations (i�se addihonalcpages as necessary)
Reviewer/Ins ector Name
p 1� dZ 1J`. LL
Phone: (, g
0
Reviewer/Inspector Signature: C
44
Date:
Page 2 of 3 1 12a8/04 Continued

Facility Number: — Date of Inspection S
•Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E,_YNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C) 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?
❑ Yes
D. No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
YJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNoo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EI o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[I NA
[I NE
and report the mortality rates that were higher than normal?
7No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
❑ 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
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes[
o
❑ NA
❑ NE
Additional Comments and/or Drawings:. „ e,
Page 3 of 3 12128104
Page 3 of 3 12128104

Divrsion of Water -r ,4 _
Qualrty -� ;
Faculty Number 3 (� QDivtsion of Soil and Water Gonservahon
_>
,iz,,0 �Othe,Agency'-'­.��r € r
Type of Visit TRoutine pliance 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: L� JJ� I lh I Arrival Time: Departure Time: County: 0011)) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: a C a kr'c- ? 1 Tu
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d = Longitude: = ° = 4 = «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder 112xv T.S
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes UrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes I
ElNA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

M'
Facility Number:3+ — 60 Date of Inspection 8
�t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UQ Gvi+v I LA (wN L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 If3-1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Ld 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
WNo
❑ 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 tth at,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes
L�J 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
2(No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2f No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0'**No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
Comments (refer to°question #): Explain =any'YES aifswers and/or any°recommendations or any other comments':
Use drawings. of facilityT.to abetter explain situations (use additional pages asvnecessary)
_ s
Reviewer/Inspector Name 6: _ Phone: % I
Reviewer/Inspector Signature: _ Date: rl & Aq
Page 2 of 3
12128104 Continued

l
Facility Number: r — a 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 ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E J 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?
ElYes
[ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
rNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VN9
El NA
El NE
27.
Did the facility fait to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I� No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2/No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C N
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
,��No
L/No
❑ NA
❑ NE
Additi©na] Comments and/or Drawings:
Page 3 of 3 12128104

v l
r0 O a rODt�
Type of Visit (!f'Com Hance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: €31JPt.Z)J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: (,E-0a-GrG -PF_=U.S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 ❑ I ❑ Longitude: ❑ ° ❑ d ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer j 7.Qo o ❑ Non -Layer
❑ Wean to Finish
® Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder,
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLayers
❑ Non -Layers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
❑ Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:
Discharp-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
❑ No
ElYes
2/No
❑ NA
❑ NE
❑ Yes EI No ❑ NA ❑ NE
12128104 Continued

+Fpcility Number: 3(— a Date of Inspection 4 0
ti
Waste Collection & Treatment
4Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: V3C�/1 1 LAG-evJ 7--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L ( 44
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
VNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
U<O
64 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
I_I No
❑ NA [--IN E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
��
LI No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Cl/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ea"No
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
o
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,�/
0J No
Cl NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ 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}:
.. a
Reviewer/Inspector Name �o W N r1zN Phone:
Reviewer/Inspector Signature: Date: p G
rage z of ) RL/4U/VY l Vleeers"CU

5
i
Facility Number: o Date of Inspection 04
t
Required Records & Documents
IDid the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes dNo ❑ 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 0 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?
El Yes
❑ NA
❑ NE
VNo
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
VN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E i No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[J No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
k10
❑ 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
E3No
❑ 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
L'J 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
E211VO
❑ NA
❑ NE
Additional Comments and/or Drawings:.Y
Page 3 of 3 12128104

Factli>zy°Number
�
Division of Water Quality
Division of Soil and Water Conservation'
N�
Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ElDenied Access
Date of Visit: ' I Arrival Time: 04S* Departure Time: County: B✓PL��I✓ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: GEsa�6 Prr��'f/S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = i � « Longitude: 0 ° = d =
di
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
/7.�eS 6Cr4 ❑ Non -Layer
El Wean to Finish
CM Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
❑ Turke s
El Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ DairyCow
El Dairy Calf
❑ DairyHeifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E]
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 n No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
' ❑ NA
❑ NE
El Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
,._,�
LQ 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: (At!06AI �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5'6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 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
9/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
notify DWQ
threat,
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
7N9
❑ 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
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
ElYes
010
❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
u,) 'L'ovr as(_
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
[I NA El NE
❑NA El NE
Reviewer/Inspector Name I d Phone:�L 7
Reviewer/Inspector Signature: - a-Itg, Date: 3 by
Page 2 of 3 12128104

Facility Number: -- Date of Inspection
Required Records & Documents J
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other ,_.., /
El Yes LyNO El NA ❑ NE
❑ Waste Transfers /❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Codc
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O'�o ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall ❑ Stocking
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Yes ❑ No
❑ Yes EKo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes -CJ No
❑ Yes dNo
❑ Yes E5No
❑ Yes ONo
El NA El NE
❑ NA ❑ NE
❑NA El NE
❑ NA ❑ NE
Page 3 of 3 12128104

`i
Division of Water Quality
Facility Number 1 3 Ea 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Comppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 040"Utine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: S 3a 7 Arrival Time: //d G Departure Time: County: akPt—ltf Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =' 0" Longitude: = 0 0 ' [-] "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Er/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — a Date of Inspection I �I3o1 rJ / J
_ f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2rNo ❑ 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: _ (L_Csaan! 1 _ A,v6n/
Spillway?:
.
Designed Freeboard (in): _ f 0,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[?No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ZrNo ❑ 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
E! No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L' o ❑ 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
�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
^any
10. Are there required buffers, setbacks, or compliance alternatives that need
❑ Yes
E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ld No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WIo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
U.TGo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ 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):
AL
I
Reviewer/Inspector Name J Phone: 0/0 U f7�
Reviewer/Inspector Signature: Date: a o
1 12128104 Continued

} F cility Number: 3 l Date of Inspection 3a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes ITNo []NA ❑ NE
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
ElNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
["No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No EJ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ko ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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
ErNo
❑ 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
M-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;1-1�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

0.15ivision of Water Quality %
Facility Number 3 G a 0 Division of Soil and Water Conservation J
-- - 0 Other Agency
Type of Visit (�'C,�o/mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G7 Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 GI Arrival Time: i0 Departure Time: �] County: b-41p4ZA) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 6415Ja.CE �Etl-u+4 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =]' = Longitude: = o = A
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
© Wean to Feeder 11 U11. 1A13'Q
❑ Feeder to Finish
❑ Farrow to Wean
5E Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E
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 L7 No ❑ NA ❑ NE
El Yes
[I No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
IZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection
Paste 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: LA&or,.r l LA &—cal "t—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Vo �3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ief 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 0 o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes YNo ❑ NA ❑ NE
❑ Yes E?No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E2"No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes oNo ❑ 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 E 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 t0 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(_ 6- 4 )4) ,S6 a
13. Soil type(s) 4-004 ar& (, OL DS130 0,0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment?
❑ Yes
o
El NA
El NE
W❑
No
❑ NA
❑ NE
ET"No
❑ NA
❑ NE
LJ�
El NA
❑ NE
L'JNo
❑NA
El NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name r ��jyQ L L 1 Phone: /d 7 f 6
Reviewer/Inspector Signature: Date: L7 a 1,
rage z of s 1L1.161u4 c,onanuea

Facility Number: 31 — 9 Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes YKc�N[]
El NA ❑ NE
El Yes NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes
21�o
❑ NA
❑ NE
ElYes
2<
❑ NA
❑ NE
❑ Yes
EKo
❑ NA
❑ NE
❑ Yes
BNo[]
NA
❑ NE
❑ Yes
❑ No
9NA
❑ NE
❑ Yes
O o
❑ NA
❑ NE
❑ Yes
PTo
❑ NA
❑ NE
❑ Yes
Vo
❑ NA
❑ NE
❑ Yes
LJ'No'
❑ NA
❑ NE
Cl Yes
SNo
El NA
El NE
❑ Yes FWo
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number �6U
kA
Division of Water Quality
0 Division of Sail and Water Conservation
O Other Agency'
Type of Visit Ortompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (?'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 6 ' 7 Q Arrival Time: �� % 0 Q Departure Time: �� County: a /lam Reglon:Av U
Farm Name: Scar r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
64."-
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
Phone:
Phone No:
Integrator: C/r
Operator Certification Number:
Back-up Certification Number:
Latitude: = o a 6 = Longitude: = o= 6 0 6f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i ElLayer
I I' ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes I'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
D-No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 2 —j Date of Inspection 4
' 7 0
Waste' Collection & Treatment
Ir-
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'C�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: 2
Spillway?:
Designed Freeboard (in): a
Observed Freeboard (in): 0-7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O'No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes _0No ❑ 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 L'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 ,0 No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) C/%f i �5e�/`i%r!/Wl�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'p-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
Q_No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Jallo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
ogments (refer to question #) 'E
Reviewer/Inspector Name l�oc✓�a�src,/ Phone:
Reviewer/Inspector Signature: Date: /D R 7 0
12128104 Continued

Facility Number: 31 Date of Inspection
Rouired'Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes -ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,2 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 00Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ElSoil Analysis ElWaste Transfers ❑ Annual Certification
ElRainfall ❑ 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 ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes --ff No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 2 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes EjNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 0-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes J�lNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes _[31No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes UNo
❑ 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 O'Flo
❑ 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 _ZNo
❑ 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 _,ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes FKo
❑ NA
❑ NE
Additional Comments and/or Drawings:
a ►� 5)►Sh ILJ otA 6`F -j i ,,AP3o -Putt A�rxCuA npl r-�' P ve,,-
}
C O a -Q A--Ve- Lk Wc� Is F�
a�11 ,Cr t a'- ✓ R
> e 5 e t oc w- A �
c�4 /�
/ r/
+ t�Orl /Zile f X e tuna le G</P.e�S o vt 614ela
G5l �h� w eaGp C onlzo / /zeeo&cV
CC 0 110G � 0
y
12128104

Type of Visit A Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 91Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other E3 Denied Access
Facility Number Date of Visit: fl Tune: uyz�
I -0 Not Operational 0 Below Threshold
)ZIPermitted. [3 Certified 13 Conditionally Certified 13 Registered Date Last Opera" Above Threshold:
Farm Name: ,4 -,e-- County
01)
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: ----07- - .. Integrator- gvzv--
Certified Operator:
Location of Farm:
Operator Certification Number:
I&
V(Swine [3 Poultry E3 Cattle El Horse Latitude 0 9 &4 Longitude 0 1 C;
Tip di
Wean to Feeder
ff7m
La
Feeder to Finish
Non -Layer
Farrow to wean
Farrow to Feeder
F
Farrow to Finish
-
R Total Deq9-
-� . . . . . .
Gilts
0ars
Boars
. .... .....
,Ca cit
!MI. , _pa_ --yRl
B11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes P"No
Discharge originated at: 0 Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? 0 Yes 0 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) 0 Yes 0 No
2. Is there evidence of past discharge from any part of the operation? 0 Yes XNo
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 �v
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes No
V5t7 1 S7rture 2 Structure 3 Structure 4 Structure 5 Structure
Identifier:
Freeboard (inches):
.12/12103 Confimwd

Facility Number:
Date of Inspectiono
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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Pverload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
Q/'
13. Do the receiving crops differ with those designdted in the Certified Animal Waste Management Plan (CA
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?
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18_ Are there any dead animals not disposed of properly within 24 hours?
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ^
❑ Yes);YNo
❑ Yes V—f No
❑ Yes 9No
❑ Yes VNo
❑ Yes X No
❑ Yes XNo
❑ Yes ONo
❑ Yes L340
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ff No
❑ Yes �dNo
❑ Yes dNo
❑ Yes No
❑ Yes Rio
❑ Yes No
Camamieats (re%r to�gnestiva.#} Ea�lam any YES mmveis aaed/or any or any, atiter oommen�s. � �
_.
R[3se dravvrregs of fasTety to bettber �m stmat,o�s (asc anal PaB� � rY) -� ❑Feld COPY ❑Final Now ��-';
rr
•
044—` SE 5
fid IDA)
0�
Reviewer/Inspector Name• �' -�,
Reviewer/Inspector Signature: Date:
12112103 Condnued

Facility Number: Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ! o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes j2 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �To
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 21"No
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes 'Q'f4o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Freeboard problems, over application) ❑ Yes J1Cio
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes PI""'
28. Does facility require a follow-up visit by same agency? ❑ Yes �No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes :O`N'o
LAMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ;?<o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

e
O Division of Water Quality
F2tcll tyNuMber Q Division of Soil and Water Conservation
O Other.Agencv
_3
..-. z .
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
f
Date of Visit: pj Arrival Time: Departure Time: '1ii County: Region:" �Q
Farm Name: L✓�f"0= /�►C/.�Sf.IQG'xs ��Owner Email:
Owner Name: % f9�'cyF.��c Zf49"� 17-1�n_ ' Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative:
/��
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:A5Cff_cnxo
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ` = Longitude: = ° = 6 = `1
ZOO �p
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ a er
/ ❑ Non -La er
❑ Wean to Finish
Wean to Feeder
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
[I Pullets
ElTurkeys
ElTurke Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man -trade?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man -trade?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ONo
❑ NA
❑ NE
❑ Yes 9No
❑ NA
❑ NE
12128104 Continued

f ti
Facility Number:, —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
El NA ❑NE
Structure 1 S�trruucture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:. e �_
Spillway?:
Designed Freeboard (in): % 9 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ 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?
❑ Yes gNo
❑ Yes ❑ No
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 )Z 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 /fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus []Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El EEvid ce of Wind
Drift F1 Application Outside of Area
12. Crop type(s) lr a ow di9-Z�
13. Soil type(s) An 2-242a-0
r
14. Do the receiving crops differ from those designated in the CAWMP?
,{
❑Yes }CJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'!
❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
00No
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R�No
❑ NA
❑ NE
/d
z
Reviewer/Inspector Name Phone:
D r G
Reviewer/]nspector Signature: a Date: &7/32
12/28/04 Continued

}
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ VAJp ❑ 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit?
❑ Yes
PKNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;A No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No ❑ NA XNE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo ❑NA ElNE
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
LNo ❑ NA ❑ NE
Addttioual'C©tumenfs,andl6r Diawings °. ;�r° >� F ��`w
72'
12128104

Type of Visit 91 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: D _ime:
FFacility Number
10 Not Operational 0 Below Threshold
0 Permitted ❑ Certified ❑ Conditionally Certified 0 Registeredrq� Date Last Operated or Above Threshold:
Farm Name: QL4 -rt3{`} Fi`{t5 I v~ �` County:
Owner Name:. �, �;�(iar Phone No:
Mailing Address:
Facility Contact: 22 Title:
Onsite Representative: Rn t3 I_Fm VPt�TS
Certified Operator:
Location of Farm:
Phone No:
Integrator:p���^
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� a Longitude �' �• 0 k
Design Design Current DeSEgtt Current
_
Swine ':-Ca acity� Po ulation Poultr} C acaty: - Po utation Cattle. Cs artty_' P© alation
Wean to Feeder I t 12 00 ry n Laver I I "' n DairyIWI
U Feeder to Finish
`.' ❑ Farrow to Wean
�] Farrow to Feeder
❑ Farrow to Finish
U Boars
Number: of Lagoons
:Holding Potidsff Solii.Traps
Discharges 8& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:\pa 21
Freeboard (inches): 3Q 2-5
❑ Yes x
No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes f"No
El Yes /VNo
❑ Yes X
No
Structure 6
05103101 Continued

i V
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
P No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
ENO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
ElYes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level�
elevation markings?
El Yes
EINO
Waste Application
((
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence o over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
�No
12. Crop type
13. Do the receiving crops differ ith those designated in thl Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
ElYesocl�c)
#No
This facility is pended for a wettable acre determination?
ElYeso
15. Does the receiving crop need improvement?
ElYeso
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
V No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑Yes
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
[ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
jXNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
VNO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commeats:(rc&r."to recommendatians or sny other camme€�ts.
Use drawings of facility to better explatnsituattons: (nse atiiltdorial page§'as oec> scary) _DFina1 Notes
Field Conv
.'. A 4
5! Du L-0 t-A O r►K F o,,to ` N tC, o m E [ R Ns i-i rv-- s
AOac NS�'r( +2n(tz�1 �7�Dn1 NFr,DEM, 50W, � SPRA�FkE
D�
�a��.. ��r� ��pF,a lJ��zc F rfr=��� RFmourz UNgsrF
N F T� S 70 e C LAP{?�;'TF� '�p
z_5 F4r(\ 51�DuWo
Reviewer/Inspector Name C
Reviewer/Inspector Signature: Date: j/n 107-
05103101 Continued

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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?
C6 EC K f---O
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes fVNo
❑ Yes 9No
❑ Yes X
No
❑ Yes ❑ No
Qa5rafO F 2 NA
bur. � NcavvlJ Of2z-5-ZarJ Loom{
2. f1L r"o-t" tAC_ FRFrz- bvP,Rb SF-F-
6021- X 0P-,-7ER.
CO PEVO VR F-F"WO �ENDTIJC--5
(ko'o 2ob22 VzRs-r Qu R R-rER.
ct� C'F' 1� o w O \-" © �
O5103101
Fo R Zoo 1 fi)P-vN- 0uwT,
-T S V FR Wett-
T
`fY-7oA)
50
HMO

r
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 Date of Visit: I� Time: !__F
0 Not O erational Q Below Threshold
Permitted © Certified 0 Conditionally Certified [3 Registered Date Last Opera"or Above Threshold:
Farm Name: ..Y..........` Sf.......................................... County:....... .......�....... ...... .
OwnerName: ................................................... ........................................................................ Phone No: ........................................................................... ..... .....
FacilityContact: ............................................................................... Title:................................................................ Phone No:
MailingAddress:---•--•--....................................n.................................----.................................................................................................................... ..........................
Onsite Representative:. `G'^�vQ..,D�.......................................................... Integrator:... ` ...................._.... �..
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..... .............. ..- .... ........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 44 Longitude �• �6 «
Design . Gunrent : Design Current °Des�ga Current
Poute CapacityPopulation CacPo ulation CattlCa cPo elation , a`
Wean to Feeder aGQ ❑Layer ❑Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy =
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other _
❑Farrow to Finish Total Design Capacity
Gilts
❑ Boars Total SSL-W=`3
Number of Lagoons _.:.] Subsurface Drains Present ❑Lagoon Area . I[] Spray Field Area ;
`Holding Ponds ! Soud Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any pan of the operation?
❑ Yes
4 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
PfNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
jf No
Structure l Structure 2 Structure 3- Structure 4 Structure 5
Structure b
Identifier: ........................................................................................................... ...........
Freeboard (inches):
5100
Continued on buck

�J
Facility Number: 3� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
JMN 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
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
V No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
r t No
12. Crop type b 3 � Yio y - _ _ _
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
O No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
WNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Jj qNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
�es
❑ No
Oe/ WUP, checklists, design, maps, etc.)
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
1,:;'No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
*o
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24. Does facility require a follow-up visit by same agency?
❑ Yes
[�(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
A No
1♦Q Yiolal iQt>is :off d�f cieu�ies vvre noted dig 'visit; Y owjr will xee�ive do fu>�-thgr
�arresent:e a�vut this visit` .. .
..............
Comenls (refer toqueshon #) Explau%any YES answersand/or any recommendations or;any other comma
n m
Use drav�ings of facility to_better explain si. ons "(use_ additionalpages as_a
eces ary}
r ��f--� . ��5� �•-� vow—rrv�C1�.T t�\C . i�G.i C''oP
�w t �� �-. � �.r . '�•� s c,.�..x �-,,e.. �, � Pam;-•- c�,5 �, �L-e.
x
Reviewer/Inspector Name fi3
Reviewer/Inspector Signature: - Date: 5/00

Facility Number: ''J% — a Date of Inspection U Ci
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below b(Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )q-No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �-No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 'qNo
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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes OgNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes �� 11LYNo
Additional,Comments an or wings:
CCU
�S-�.
T�
� �� t�� \�s ✓--��-�.\`�s c�l.� P��e�e\ law
7
Lfe- ��- s� e sue ` Let l le-i
Z- V-e5 L-A A-'V 0
5100

r
Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency'
of Visit - l0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J2rRoutine Q Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Bate of Visit: rime: : ! Printed on: 7/21/2000
Facility Number
Q Not Operational Q Below Threshold
[.Permitted [a Certified E3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
CFarm Name• — t t..... .N.1................................................. County:.-... .. ..l y ..�.......... .... �....
OwnerName:,............................................................... Phone No: .......................................................................................
Facility Contact: ,�.r"...........�_ .1M..!. Title: ......... �A,t7AP!1►�................. Phone No:
....................................................
:'Mailing Address: ........... .............................. .................. I............ ....................................... ..........................
Onsite Representative: D.Y` �! ' `t-...........1, ........................ Integraton ............... :� . C....l. ............... P ...............
Certified Operator:,.•,•,-.-h- Y..l`74 �� .s.................. Operator Certification Number: ............•„•
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �� �•� Longitude 0 ��«
Design Current Design Current Design Current
Swine CapacitX Population Poultry Capacity Population Cattle Capacity Population
M.Wean to Feeder f 1. 7A7D JE1 Layer I I ❑ Dairy
❑ Feeder to Finish ❑Non -Layer ❑Non -Dairy
arrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges &c Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, slid it reach Water of the State'? (if yes, notify DWQ)
c. If discharVc is observed. what is the cstiinaied flow in gal/rain?
d. Does discharge bypass a lagoon system? ([f 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
Stru,�ftfe I Stru*ur2 2 Structure ; Structure 4 Structure 5
It
Identifier: l►
Freeboard (inches):
5100
❑ Yes
r
❑ No
❑ No
Yes
❑ Yes
ZNo
❑ Yes
0
❑ Yes $No
Structure 6
Continued on back

'N
VacilityNumber: Date of Inspection QE00VPrinted on: 7/21/2000 1
5- Are there any immediate threats to the integrity of any of the structures obs rved'. (ie/ trees, severe erosion, El Yes {]�No
seepage, etc.) --
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ 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
[k(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
To
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[(No
Waste Application
10. Are there any buffers that need maintenance/improvement`?
❑ Yes
,fNo
11. Is there evident of over application? ❑ Excessive Ponding ElPAN ❑ Hydraulic Overload
❑ Yes
9fNo
12. Crop type U V S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
§;rNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
B10
b) Does the facility need a wettable acre determination?
❑ Yes
[kNo
c) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15. Does the receiving crop need improvement'?
❑ Yes
ro
16. Is there a lack of adequate waste application equipment?
❑ Yes
CR�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
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
PNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) [-]Yes NNo
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes kNo
24. Does facility require a follow-up visit by same agency? ❑ Yes lie
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes kr&0
��io •yiolaticjtis oi' deficiencies -were noted• ding this:visit.' • Y:ou will-teeeiye do fufthe�
icorrespondeirce. ahouf this ] isit........:..: • : • : • : • : ' : ' : ' : ' :.: • ::: ::: ' : ' :: ' :::::::: :
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):
eloLS �' .ate-- w'^�'L" a�c�,�ro..b � -� -•�•` �s �.,_ P `.�, � o�-- .
—CAI 5
W 0. f Anr� VNA s 4A14A-- pvv4— flai �� °
N-44,h L-4— T w" `vv�­ I0 C^A' i�,` .v o`�t ►.vi l�
P qr
Reviewer/Inspector Name V
Reviewer/Inspector Signature: oe
0
Date: �Q- 03 ' �jq- - 5100

1~acilrty Number: 77 — Date of Inspection ( U3 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes N0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesN0
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 Wo
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 �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes r0
3tDo the QVsh tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes RNo
a ."A \\
kdditional C6mments and/orDrawings:
L 6AL
Colr� An
C
Ao
1
�.�(Wc� �.
—Dlivi—, N •L-
- rJ
5100

Division of Soihand`Water Conservation EOperation Review r/
U Division of Soil and Water Conservation 'Compliance inspection
R9
:Division of Water Oil, .;ComEianee Inspection
Other Agency Opeiratxon Review r::
IQ Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted [3 Certified © Conditionally Certified 0 Registered 113 Not Operational Date Last Operated:
Farm Name: .... L�N1- ........ .-LVIi:��..............................�..... .......... county
:.._..ii'�.............--............... _-..........-.........
Owner Name:..... -. (014vYL............. . Phone No: .... -- -.� #
,J .x�.... ��1��...3.-.....d................
Facility Contact: .. `k..! ................... �.�tlf4 ....................Title:._......................................... ....-..._......... Phone No:.'.�.� ............
MailingAddress: ........................................... ............................... ............................................................ ..........................
..... *.......
- ......
....
Onsite Representative: .. �! ...: y4L+.hn....... .... �'�kbt1!...... fl#.s........ Integrator:............C�YU..!...............................................
Certified Operator: .._.rQC� -...........f�i.'L._......JX.:............. Operator Certification Number:.... /?2-71 .................
Location of Farm:
Latitude Longitude �• �� ���
Design Current , Desi _
gn Current Design Current .:
Swine Capacity Population Po%iltry =_ Capacity Population Cattle Capacity Population
Wean to Feeder f ❑Layer El Dairy
❑ Feeder to Finish ` n ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
u ❑ Farrow to Finish Total Design Capacity
❑ Gilts
=. ❑ Boars TotaLSSLW
-Number of Lagoons ❑Subsurface Drains Present ❑ [ agoaa Area ©Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made'? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes A No
c. If discharge is observed. what is the estimated flow in gallmin'? /VA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes UNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes EZ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IjNo
Structure f Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Nurse
Freeboard (inches): ......... 3P.......... I......... ...........2 k
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes OfNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
►' closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidences of over application? ❑ Excessive Ponding ❑ PAN
NU
12. Crop type C. ,<A _ RP . �A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
s
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?
0: N,6-*i61htidris;or deficiencies were noted dining (hjs'visit.* • Y:oif ;will•reedW do further ....
corresponnence. about this visit. .. . .. . .. ... . ........... .. ...... . ..
nments (i efer to:questioi*): -
❑ Yes [9 No
❑ Yes No
❑ Yes No
❑ Yes 7 No
❑ Yes q No
❑ Yes V3 No
❑ Yes No
❑ Yes No
❑ Yes 5Q No
❑ Yes IR No
❑ Yes t(9 No
❑ Yes 19 No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes M_No
❑ Yes 50 No
rs'and/or' any recommendations or any'other coenis- -
addti©nal.pages°as necessary} N e
FDOgg
1�i�1 �DS
6��d e �/ a__Ad.
L
Reviewer/Inspector Name —'
;%r= ;
Reviewer/Inspector Signature: Date:
3123/99

Facility Number: 3 —
Date of Inspection
• Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
JNO
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
( 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
j 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
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
IQ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
CTNo
3/23/99

4 1­1 Division of Soil and Water Conservation 0 Other Agency
�� tvision of Water Qaality ��
IffRoutine. O Com laint O Follow-u of DW ins action O Follow-u cif DSWC review O Other
Date of Inspection 4
Facility Number el Time of Inspection 2A hr. (hh:mm)
0 Registered aCertified AApplied for Permit 0 Permitted [3 Not Operational i Date Last Operated:
Farm Name:.... .'.G - .... '' 9 ..l. a. .......................... County:..... � i ,�11. ` .............................. I......................
Owner Name:......tj.....`'St^1 `.....�....... .`� Phone No: ... G.....!.2.- ..........................
Facility Contact:---.-......................................................... ---- Title: ...... Phone No:
MailingAddress:.,? `b................................ ..'...'^... :T` ............ �.r.- .K�........�,...�.. 1...................................... ..........................
Onsite Representative-l-;►..!]. ............................... Integrator: ..... \.'Q....Q................
.......................
Certified Operator:............................................................................................................... Operator Certification Number,........................... ..............
L tin of Fa
XL L
W, �...`T +-,.... :..:....... ... .... �' . A6..a.......... ...� ... ,..S..r ........o .._ ' ...... .
Latitude 00
=' 0" Longitude 0• =1 =11
Design ';' Current
_
Design Current- Designs Current
5wtne Capacity riPopulatron
x
n Pal try ,' ''-Capacity
Population Cattle Capacity Population "
Wean to Feeder \'_OG
El Layer
❑Dairy '.
r " ❑ Feeder to Finish
❑ Non -Layer
[] Non -Dairy`
❑ Farrow to Wean
ElFarrow to Feeder
❑ Other
s
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars'
Total 55LW
.... .,_.
fi
Number of Lagoons / Haldtng Fondsl,�,
A
❑ Subsurface
Drains Present
❑ Lagoon Area
10 Spray > �etd Area
'
❑ No
Liquid Waste Management System
f
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
O(No
2. Is any discharge observed from any part of the operation?
❑ Yes
MNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
N No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
6No
c. If discharge is observed, what is the estimated flow in gal/min?
NA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
VNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
g No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
P(No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
P'No
maintenance/improvement?
6_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
'0 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
VrNo
7/25/97

Facility Number: '3 —
�I
i
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes
No
Structures (LagoonsBolding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
................................... ....................................----......................................................I.................................................. ............................
Freeboard (ft). 3 , (............... ........................... .........
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
0 Yes
� No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
19 No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13,
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
0 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
gNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type.1 ...��.:� ...................... ��
.......
16,
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
O, No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
19 No
18.
Does the receiving crop need improvement?
❑ Yes
fSrNo
19.
Is there a lack of available waste application equipment?
❑ Yes
MNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
g(No
21.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
O No
22.
Does record keeping need improvement?
❑ Yes
1--rNo
For Certified or Permitted Facilities Ong
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ONo
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.vialations,or. deficiencies: were• noted-dtiring this:visit.- You:W_iff 'receive no,firther- : -
:-:•corresp�ndei�cealiou�t�is:yisaf.•:::::-:•: . . . ,.-:-:�:•:•.•. -:�::-:..:: �•:�::�: _ : .�
7/25/97
Reviewer/Inspector Name
IReviewer/Inspector Signature:
Date:

F/
ffls—
v7 f d
❑ Division of Soil and Water Conservation ❑ Other Agency��
Division of Water Quality
-�', � , .�„_;E : � sum.-��d; ;�-� - ..,�,.�- �:� .. _;; - _•. �-;,�-;� � �:, � F . � .. < { :'.. . ' .�._ d �
Moutine O Comolaint O Follow=uu or mvO insoec:tion 0 Follow -tip of DSWC review 0 Other
Date of Inspection )11641-7
Facility Number Time of Inspection SU 24 hr. (hh:mm)
Registered 16 Certified © Applied for Permit [] Permitted 10 Not Opera Date Last Operated:
Farm Name: (_ County:....... �iu'
................................. !...............
Owner Name:........c�9��......... OV.4an....................................................................... Phone No:.ic.110Z 17a-.. S5.M........................................
Facility Contact: ..
........��.o,.........Qi1.l�h............................. Title:.........4L�:1�4�.....:....,............................Phhone No:..�°�Li��..Z93.:'.�....
Mailing Address:......,? ........ �!!�e ks....../i� .ft.......t'Y� ... ........ ............................. frL�.A YS Q.II�....7..d`�..................................... ... zc%3 �1 ....
(k ........ a ................................
Onsite Representative......._..(.. V-0,1 ........5. U-Ikl ! n................................................... Integrator: ........ . r .
Certified Operator............................................................................................................... Operator Certification Number................................
Location of Farm:
4as s....l +t ..N... ra�......!J�arxa ...i.� ..C�.. u .. sk..... �........ t.,xw�..........s.. v iu n........ r.t1.a�....
sR..l + Gt..... ,x►�...a-.....4.:.S.x�a ...... .�, .....SR....►. ....0r .... sav+W44�....5S'd.e.....................................
Latitude Longitude 0• �' 0"
Design`; Current; y¢ Design Current * F Currein!
Swine Capacity Population ... Poultry a ., CapacityPopnlatian Cattle Capat ty Papulation
IN Wean to Feeder 5 jp QQ ` ❑ Layer _ ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non-Dairy
Mels
❑ Farrow to Wean
ElFarrow to Feeder ❑Other F b zrr
❑ Farrow to Finish ` -
Total Design Capacrtys
❑ Gilts
❑Boars -TotaI,SSLW>
:Number. of Lapeons / Holding Pends ❑ Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
4y�----��,
-
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notifft, DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4.. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [C No
❑ Yes W No
❑ Yes No
❑ Yes No
tilA-
❑ Yes ® No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
lP No
Continued on back

Facility Number: 3 — (
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
to No
Structures La oons 11old i Lig. Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
iR No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): .......... i b.................................
10. Is seepage observed from any of the structures?
❑ Yes
[A No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
5]i No
12. Do any of the structures need maintenance/improvement? °
Xj Yes
❑'No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
'P No
(If in excess of WNW, or runoff entering of the State, notify DWQ)
+waters
15. Crop type .................. C.acn.Whktk......................................:S 9_. ...................................................................................
.......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
® No
19. Is there a lack of available waste application equipment?
❑ Yes
1] No
20. Does facility require a follow-up visit by same agency?
❑ Yes
® No
21. Did Reviewer/Inspector 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
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
V%, No.violati6ns or. de'rieieitcies. were noted during this. visit. Nou.will receive" no ftirther
eorrespondenee About this; visit'.,'.
tents (refer toquestion,#):, Explain any YES answees and/or any rec
r
swings of facility�to better explain situations Oise additional pages
12 lio�r� ra,t(ks Skeuld 6t rc�edttj- (t l !! jj� �11
zi" Sort ks+ c�v►cl ifY1'30L `oA M&P �JJ be it c&444 plan. Spy ricca-Js �y1i) 6e ' �1`T
by �uj1 Aumbw av,u} �_eld rv;4w.
7/25/97
Reviewer/Inspector Name I� Y 1ll�ne to v.;
Reviewer/Inspector Signature:— Any. le'—, Ak - Date:

G-
Jw, �r
llF.272
Division of Soil and Water Conservation ❑ Other Agency
®Division of Water Quality
iCPRoutine O Cotnplaint O F+)llou--up of l)i4'Q inspection O Follow-up of DSWC review O Other
• w Date of Inspection
Facility number � Time of Inspection Ei �/0 24 hr. (hh:mm)
g pp 13 Not O erational Date Last Operated: Re tsti:red Certified ©A lied for Permit ©Permitted
Farm Name: a.vvyxX\..._. &r*.*,......Owmn �. Z County:.... U ��Y`.............................................................
Dinner Name:........ !.M ...... L+1J............................. ............................ Phone No-....( .......................
Facility Contact: ...... .....I. ....l,.Yt %nn........................ ' � r _ �.,...]... Title: ......... Q1e1.I7R.Y......................... �,P3hone No:..��1.��..�.g.�:.��Y:`.�......
MailingAddress:...... �....... 1A).a 5......V: �......1?,.A..............................................�ii�[�1%aO,......0�...................................... . ... z$�U......
Onsite Representative: ..... Cicill5 VinV%......................................................... Integrator: ......... 1.r-[.......Q..............................................
Certified Operatorz............................................................................................................... Operator Certification Number:...................................
Location of Farm:
I. �Gts}..�1-1.N.... C .....Z1} ESArr�..:...I.SN f1...` ..... 115�.... 5 .... r lhC..... ...s . k....s ..Ilyn......K^.............. i
e. ..o,�...'5AJML...115r.fxr.... ,........ f�,..S......szdz....c.. k-k....................... .
Latitude 0 6 69 Longitude ' �� �44
F Design - Current
Design CurrentDesrgn.Cnrrentt
Swuae r Capacity Populattan
: PpuEtry Capacity Populahoa Cat#Ie ;t Capacity Populahan c
Y Wean to Feeder pp
; ❑Layer ❑ Dairy
a `Y`
❑ Feeder to Finish
I0 Non -Layer I 1 410 Non -Dairy{
: < at
❑ Farrow to Wean
-;.
❑ Other I ,&,
❑ Farrow to Feeder
Total Design Capacity
❑ Farrow to Finish
❑ Gilts`
v Total SSLW
❑ soars'
--Number of Lagoons ! Holding Ponds
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area k
Z.
❑ Na Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated'at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
A. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5., Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25I97
❑ Yes P4 No
❑ Yes Da No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
[3 No
❑ Yes
to No
❑ Yes
03 No
❑ Yes ILV
M No
❑ Yes PQ No
Continued an back

11
Facility Number: t —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons.11olding Ponds. Flush Pits etc.}
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes q No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): .............3 ......... ............... .................................. ................................ .................................... .................................... ............ I.......................
....
10. Is seepage observed from any of the structures? ❑ Yes 1A No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need 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 ........... .........6..v-Xnja................urr! ........... .......---..................
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?
53-No.violations or d'iciencie's.were-noted-during this:visit.-.You.will receive no ftirttier
correspondence about this: visit -' .
V1 Yes ❑ No
❑ Yes 09 No
❑ Yes IA No
.......................................
EA Yes ❑ No
❑ Yes C& No
❑ Yes W No
❑ Yes D9 No
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes [P No
❑ Yes 1A No
❑ Yes IN No
Use'ilrawings of facihty to'better explain situations. (use additional pages as;necessaiy}
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( `1
sov ,-P6 C1,Na yses vy' W 4 W,4� Shout �� i n Ccr �-ic� Pf c-A
M
�bh
11 f�11QYr � --, i IeO UtzSf^ou10 �� arn`fU s�lofr�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �/ _AJA, _ Date:

•
Site Requires Immediate Attention: /�✓
Facility No. 31
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE. VISITATION RECORD
DATE: d9 �J? , 199fi
Time: /3 ` O
Farm Name/Owner:
Mailing Address:
County:
Integrator:
r
/A)
k e L9,
Phone:
On Site Representative: Phone: d'�i 3
Physical Address/Location: l9 ( T!J
Type of Operation: Swine 1 Poultry Cattle
Design Capacity: eANumber of Animals on Site:
DEM Certification Number: ACE / DEM Certification Number: ACNEW
Latitude: JLongitude: 78 d `� ' " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 4 hour storm event
(approximately 1 Foot 7 inches es r NTo Actual Freeboard:' Ft. _Inches
Was any seepage observed from the laQoon(s)? Yes or No Was any erosion observed? Yes o \F
Is adequate Iand available for spray?(Yes r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: /_ _�iS �� CIJ�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es ' No
100 Feet from Wells? e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a LISGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o Na ' If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes -of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: z4c-700 '" vek
Inspector Name Sign ure
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. 1— 6!
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE.VISITATION RECORD
DATE: l�,3 , 1995
Time: % Sip r
Farin Name/Owner: 1-01' ,Pi$ lC 1// •1%
Mailing Address: S_;�_&
County: /���l%p61 -
Integrator: Phon6:
On Site Representative:
Phone: r — _3S_9_1
Physical Address/Location: Al,I ,PA:Sj-- 61)`
FINO
Type of Operation: Swine Poultry Cattle / / 1
Design Capacity: (Q �iJPS U 4 Number of Animals on Site: �`1 7 (n
P tY� ._
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude:Longitude:d V' 3 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot = 25 year 24 hour storm event
(approximately 1 Foot - 7 inches)(!�31r No Actual Freeboard: �_�Ft. & Inches
Was any seepage observed from the lagoon(s)? Yes r No Was any erosion observed? Yes o No
Is adequate land available for spray? Yes or No Is the cover c- p adequate? Yes r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes -of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No �
Additional Comments: GCsd?1 n� ?� l,�>z� Z,10eW
Inspector Name
Signa
cc: Facility Assessment Unit
Use Attachments if Needed.