310162_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Date of Visit: 2u 1'i Arrival Time: Departure Time: �--i• County: DIAV� l) Region: r V t
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Owner Email:
Phone:
Certified Operator: C'f jy- -
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine ffi—Ja c i
Wean to Finish
Wean to Feeder
Feeder to Finish b 2D
OilWet Poultry
Layer
I jNon-Layer
Design
C■apacity
I
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Dairy Heifer
Current
Pop.
arrow to Wean
Farrow to Feeder
D , P,oult ,
Design
Ca aci
Current
P,p
Dry Cow
Non-Dai
Farrow to Finish
JLavers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turkey Pouets
Otheri
i
1
0
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes IgNo
❑ Yes � No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Faeili Number: 121 tj 2 jDate 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 ❑ o ❑ NA -ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 %y
Identifier: I Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 38
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.) CQ
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes VNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes M 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'0
�fNo
❑ 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
[!'Q— No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
T�
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ' No
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑ Waste aners
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
5 '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
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C—] No
XNA
❑ 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? ❑ Yes K No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 09 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes N=�❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other'commentL
Use drawings of facility to better explain situations (use additional pages as necessary).
- �o4 pig in svwa
r. I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
X
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
R(No
❑ NA
❑ NE
❑ Yes " No ❑ NA ❑ NE
Vy
e4� w.� Ek#
Olt
Phone: To ZI Q 7 3W
Date: it
21412015

Date of Visit: Arrival Time: Departure Time: County: fl Region: k L.4r,
Farm Name: '��`����e�c.e Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: 1�qa
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pap.
E]
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D r P,oul ,
Layers
Design
C•_a aci_
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets.
Beef Brood Cow
El
Other
Other
Turke s
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?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ;E�'No 0 NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes J❑"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 No ❑ 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 ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: Z L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes �allo
❑ NA
0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: {6 -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -3 -3 a
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.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ,ENo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 12-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ;31�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
❑ Yes Fe No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �. JVo
[DNA
❑ NE
maintenance or improvement?
e
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes P0110
❑ 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 L�j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes _E�J'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes _J:jNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J- fo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Q.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes �p
❑ 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 ❑ 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 =o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,❑/'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �2Ao
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 P No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ohio
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑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?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Z*+Io
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
/�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes , Eno
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [:�jNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [;�Vo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes jEno
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VN.
❑ NA ❑ NE
Comments (refer to question ft 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).'
I -le GO' -'"CA /v c k c5t7 a C'/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �& �w a3
Date:
21412015

Type of Visit: �liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: .�Departure Time: County:: fr Region
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to finish
Design Current
Wet Poultry Capacity Pop.
Layer
Desigp C*urrept
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish kL2Dai
Farrow to Wean
Farrow to Feeder
Farrow to Finish
i) , P,oult . Ca a_ci Pao
Layers
Heifer
Dry Cow
Non-DaIry
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
JPullets
Beef Brood Cowl E4
Other
Other
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?
❑ Yes ,0 No ❑ NA ❑ NE
❑ Yes -n No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
.'j 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
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�J`No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

Facie Number: - Date of Ins ection: 2
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
ff No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: / 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PfNo
❑ 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
VfNo
Q NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
V(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?
'W
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,Ej No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
FeyNo
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZI No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [—]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
IV
❑ Yes 2� No
❑ NA ❑ NE
25. M the'facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes m No
❑ NA ❑ NE
❑ Application Field ❑ LagoonlStorage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ 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).
r I�' G`-��prc,�r
�oad
s�aiy-3 /s
Reviewer inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q079 7
Date: ( i
21412014

Type of visit: FrCompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: QfRoutine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: LTA Departure Time: _ County: L4�^
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Phone:
Certified Operator: CLVC _ Vb. I
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Design
Japacity
Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
op.
Wean to Finish Layer IDai Cow
Wean to Feeder
Non -La er IDa'
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D , P,oultr. Ca aci P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ No
❑ Yes J' No
❑ Yes _ETNo
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 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: W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 A No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZrNo
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
acres determination? T
17. Does the facility lack adequate acreage for land application? ❑ Yes No
18. Is there a lack of properly operating waste application equipment? ❑ Yes No
Required Records & Documents TTT
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FNO
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Vj No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 N
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below. 71
❑ 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: 1
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � I No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JZ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes ZNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E� No
❑ NA ❑ NE
if yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 2] No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes O No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ 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 exulain situations (use additional Dates as necessarv).
Reviewer/Inspector Name: I)I\ r Phone: t0 +
v �t
Reviewer/Inspector Signature. j� Date:
Page 3 of 3 21412011

Type of Visit: 7,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: p, Arrival Time: Departure Time: County: �][,,�(.1+�V Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative:
0�02LC S
Inte rator:
Certified Operator:
)11Vj-1_1, Ck
T��I.�3i -�5�
�a
Certification Number:
D14
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desigu Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish ILayer I I Dairy Cow
Wean to Feeder
Non -La er I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Cow
1) . P,oul Ca aci. P,o , Non -Dairy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
❑ Yes 0, No
❑ Yes9-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

lFaddity Number: -j to Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
IgNo
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �� • j� .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ' No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ 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 N_No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes TTT�No ❑ NA ❑ NE
maintenance or improvement? $,No
```11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windowr ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): SG Cnim l/l_}H A r 56 p
m& ag_6 Eict.e&4
13. Soil Type(s): "I AI'S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA-
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists 0 Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Waste Trans ers 0 Weather Code
0 Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections Q Monthly and I" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - I & jDate of Ins ection:
�24. Did"the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes TNo
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�k
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes XNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes] No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
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? ❑ Yesallo
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA 0 NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other. comments...m
Use drawings of facility to better explain situations (use additional pages as necessary).
�.A.
N
a
1)('11Q
�GZ�3T1o�1 �JU-r �1 �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q�GL9"
Date:
21412011

Ehviiionn Water Quality
Facility Number L? t I - ® Division of Soil and Water Conservation t�
© Other Agency
Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f i Arrival Timel Departure Time: County: Qt,t�fXJ Region:
Farm Name: C'7 L�� Q^E 1 [1� Owner Email:
Owner Name: pwAGi0S Phone: 18 - cYC/lQ
Mailing Address: S C:!4 C C- Q j 1IT JC-S C- Aa_Cf4 ej &[ -OU 1 C.LC- ,/%C D g S I R
Physical Address:
Facility Contact:
Title:
Onsite Representative: CAJAU&_>
Certified Operator: G N Q Al.?G-L L C-pw ARpS
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
cQ(41PO
Swine
Wean to Finish
DWOO esign Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
C*attle
DairyCow
Design
Capacity
C*urrent
Pap.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I) , Poul_ Ca B P,o
Layers__
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Pouets
OtherIj
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?
❑ Yes No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes [:]No
❑ Yes tNo
o
Yes
❑ NA NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

IFaciHty Number: 7g 1-70 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: D6, CG77LE
Spillway?:
Designed Freeboard (in): 145 11.5
Observed Freeboard (in): 3"K ?.R
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.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ 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
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 ❑ Application
Ou�tside, of Approved
Area
12. Crop Type(s): 5 G ?eA� L- ImT t) LL E T T IJKJ c4 .a 1 S Vn3
l/_C�f 1
�P6SCuE
T
13. Soil Type(s): VA[/VS Cpy_e 51-0,q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
tN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
OP No
❑ NA
❑ NE
the appropriate box.
E]WUP El Checklists ❑ Design []Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O'No
❑ NA
❑ NE
Q Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Q Soil Analysis
❑ Waste Transfers
Q Weather Code
❑ Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[3Yes
9No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili •Number: -10 Q Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes t
o ❑ NA ❑NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yeso ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels 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 V No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes "YtNo ❑ 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
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑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 facility to better explain situations (use additional pages as necessary).
W.
Li ritr;
c" Oq
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t.l�� (A.-,PS�XE^^P y c_A fv "L �C�11 —
r ACZ
Phone:
Date:
2/4/2011

Type of Visit ^Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )h Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I J 10 I Arrival Time: ® Departure Time: County: U N Region:
Farm Name: C DC 1(] C E Owner Email:
Owner Name: A2�E g � - �D�ACZD S Phone: - 1 �Q " �' 3 y
ta
Mailing Address: 56-a c e DA(- Foyzxs au(Zc_t4 Psi QE:uuo u t-t_L e,, /V(2 QM?
Physical Address:
Facility Contact: r Title:
Onsite Representative: C'Ww es
Certified Operator: (2444"4--g W)NZ&_L
Back-up Operator:
Location of Farm:
Phone No:
Integratorn���
Operator Certification Number: oti
Back-up Certification Number:
Latitude: ❑ o = ` 0 " Longitude: = ° = d = u
Design Current
Swine Capacity Population
Design Current
P
Wet oultry Capacity Population
Design
Cattle Capacity
C►►urgent
Population
❑ Wean to Finish
JEI Layer I I
Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
❑ Daia Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ DaiEZ Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑ Gilts
El Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 x No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3 Structure 4
Identifier: L 61
Spillway?:
Designed Freeboard (in): , . _ 1,?•
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA El NE
Structure 6
❑ Yes YNo ❑ NA ❑ NE
❑ Yes VNo ❑ 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 )kNo [INA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'ANo ❑ 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 PkNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes �No ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo
❑ 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) SL PE AeL m I e..f Tr �HEi4 S Q G-SQ4
/
[ P�
13.
Soil type(s) VAIN S rO 1LF s TCW
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D(No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes UNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yesc-G, No
❑ NA
❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Ycs AE9,No
❑ 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�Icomments
Use drawings
wings of facility to better -explain situations. (useR.additional
Reviewer/Inspector Name r Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

F:Icifity Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Vb(No ❑ NA ❑ NE
the appropriate box. 0 WUp ❑ Checklists [] Design [] Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �} No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 3 Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ JPy1nual Certification
ElRainfall ElStocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections ED Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
kNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
GINc. B ��a� 20010
St�.rDC 5(A" Fob
Fad- > C C * CC) 6 N 't�G o�0 41
l�.A.
5eA G
111,05169 r. (P 1160
8)1(416 9 � .` 1. 6
Page 3 of 3 11/ldc/04

Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit SkRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /� �LJ' Arrival Time: w Departure Time: County: uAI Region:
Farm Name: I"'SETTonwnI r Email:
Owner Name: ��+ LC� �-�V ���^�pQ�S Phone:
Mailing Address: 56� �� �- 1"OQ1Cg CHl1. ZCfl.P_ &C.iLQUJLC. E ,/VC 9g S)k
Physical Address:
Facility Contact: Title: Phone No:
Q �
Onsite Representative: .+ 5 QAA.►1CK ICilA"5 GDWODS Integrator: --1, �
Certified Operator: (2A4AU� S �1 N?eL �5 Operator Certification Number: CrN 196
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = f = Longitude: = 0 0 ' E_—] "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
❑ an to Feeder
I0 Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ElNon-Dairy
El Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Beef Feeder
El Pullets
❑ Boars ❑ Beef Brood Co
❑ Turkeys
Other ❑ TurkeyPoints
❑ Other ❑ Other Number of Structures:
Discharees & Stream imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility dumber: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �6 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PkNo ❑ 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 DkNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes A No ❑ NA ❑ NE
1. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding . ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > l0% 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) > H 66 T 26aes. 1 rn' 1[.t.E is SC, COd 6_Sso_t E C P�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RkNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes U(No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes %LNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Po ❑ NA ❑ NE
°Comments (refer to questron:#) Explain any YES answers astd/or.an y„recom�ne atians or:any other comments;
kUse drswrngs afifactlitytabetter explain'si#uattons (use additioifiF ages as necessary) rt
Reviewer/Inspector Name I Phone:
Reviewer/Inspector Signature: Date: L41 [ 01
Page 2 of 3 12128104 Continued

Facili j Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )kNo ❑ NA ElNE
the appropirate box. ElWUp 0 Checklists El Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �ANo ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑Xaste Transfers ❑/mual Certification
[] Rainfall 0 Stocking ❑ Crop Yield Q 120 Minute Inspections 0 Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
X No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes _0No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[1 Yes MNo
❑ NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ANo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes :No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes JANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 'o
❑ NA
❑ NE
Additional ;Comments -and/or Drawings
....�,.
qa, Josh 1•s � • �°
Page 3 of 3 12128104

0 Division of Water Quality
Facility NumberE
f (y a 0 Division of Soil and Water Conservation
tl Other Agency
Type of Visit R Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J&Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / op Departure Time: �� County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: � )) Title: Phone No:
Onsite Representative: LlCl ,—j l S & g_Wj0e_ IC(! r C5 C--b WIntegrator:
Certified Operator:C_i4Mt-Lf,5 WI/V �-� i�u�QGtDS,�4Z - Operator Certification Number: aL4 a�0
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E=1 c E=I' 0" Longitude: = ° =' = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
QkFeedertoFinish (Q�0 (P
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other I_.. .
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current..
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EjDry Cow
❑ Non -Dairy_
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Plumber 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?
a
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
❑Yes
El No
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes )6,LNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — Date of Inspection S O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ 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: U - r cc- i�> l G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
I-
(Not applicable to roofed pits, dry stac s and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Cl Yes} No
❑ NA ❑ NE
maintenance or improvement? \
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
[INA [INE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes f 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 A� No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes RtNo
El NA ❑ NE
17. Does the facility lack adequate acreage for land application? El Yes �No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes G 'No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/]nspector Name rnQ ArQ4C& q-/,--,f(e g Phone: JA5 3'oZ":j
Reviewer/Inspector Signature: Date: S.19 5
12128104 Continued

Facility Number: 3 r Date of Inspection% .-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes SdNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f4No ❑ NA ❑ NE
the approprrate box. ❑ VvrU`P ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes NrNo ❑ 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 4 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J�rNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ 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
64 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ATNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
q.
❑ 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
1�lNo
❑ 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
KNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

r h'
X1 Division of Water Quality
Facility Number Z11 0 Division of Soil and Water Conservation
0 Other Agency L�'
Type of Visit 10 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
Date of Visit: Arrival Time- Departure Time: Jf County:
Farm Name: / TG % Z��^ / i� y Owner Email:
Owner Name: X< /1 4414 1< C (/P Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ,S ���;4�/� � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region: Z(/'/�
Latitude: = o = = Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish L12,67 Z
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex 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 R
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: EZ]
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
[I No
Cl Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA El NE
1 /28/04 Continued

Facility Number: —
Date of Inspection ?�3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 64&-- /L
Spillway?: fl%G NO
Designed Freeboard (in);
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes ,�J No El NA El NE
❑ Yes// ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes )Z1 No
❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 11 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesNo [INA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes );�/ ❑ NA El 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? f
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /PlNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [No ElNA El NE
El Excessive Ponding El 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. 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? El Yes No El NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes /,,�No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes "' No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other, comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�/ � G✓�¢-�G'!i< //f �G�C/�7z4 N ��ir�JvuJ �Yr�� _ Y/U��✓r),,/� �i�/�,2i _ �I�PL�/
F�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: ql.11 - l/%
Date: � 7q/"3
Page 2 of 12128104 Continued

Facility Number: — ` Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ ye�0'
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.
ElWUP ❑Checklists ❑Design ❑Maps El Other 1/0
21.
Does record beeping need improvement? If yes, check the appropriate box below.
❑ Yes P(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes JNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
CCJ
❑ Yes 0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes �No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
�No
El NA
El NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concem?
❑ yes
[�lNo
❑ 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
YNo
ElNA
[INE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/t �.v ! /!�- �/�f✓G G� Cr�onJs �� �C�v� Gt/r1� C l�LG
oe�� G� UL- G Cal
C� N AeI1711-9
l 141V
Page 3 of 3 12128104

Division of Water Quality
Facility Number 2 O Division of Soil and Water Conservation
-. - ...- 0 Other Agency
Type of Visit Co lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: fhUPL_ 12 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: CPAP-C,Ui>icvA Ra_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= 0 0 i = Longitude: = ° 0 4 = «
Design �Current: , `. Design Current��
5 Design Current
Swine Capacity .Population Wet Poultry :Capacity Pophlatiori=" Cattle 'CaOity Po elation
.P,
❑ Wean to Finish Layer ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer ❑ Dairy Calf
Feeder to Finish a ❑ Da' Heifer
❑ Farrow to Wean Dry Poultry ❑ D Cow
❑ Farrow to Feeder "
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other'
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
DischaLges & 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?
-: U Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures-.='C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes t No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑NA
ONE
El Yes
El Yes
KNo,ElNA❑
NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

r.
Facility Number: — Date of Inspection o (.
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 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA 6" 1 1 A 61�N
Spillway?:
Designed Freeboard (in): r S
Observed Freeboard (in): Z 3 j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 3401
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑Xo ❑ NA El 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 0-❑ NA ❑ NE
maintenance or improvement?
Waste Application ,��
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7 No ❑ NA ❑ NE
maintenancehmprovement? ,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L�'1Vo ❑ 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) CL11)j E Lk-,
13. Soil type(s) (Z f� jj j S �cc-,1 i i td %f a o 0�uj 7`i /J
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
[TNo ❑ NA ❑ NE
E], o ❑ NA ❑ NE
ro ❑ NA ❑ NE
o ❑ NA ❑ NE
0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any. YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
(, (v TIC JJ U& Tc, " Z:WsE c.Tz o a N 41rC -'((—A -Q- Vr AJ 0`+6.
6'6-1Aj_1j
Reviewer/Inspector Name (t,�tj L- ,� Phone: — 1
Reviewer/Inspector Signature: Date: o
rage -, o] s 1Z1ZdVU4 uonnnuea

Facility Number: 3 — b Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
El Yes � No
❑ Yes ��No
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate ;S10il
elow. 'LJ Yes ❑ No ❑ NA ❑ NE
El Waste Application [I Weekly Freeboard ❑ Waste Analysis
alysis El Waste Transfers ❑ Annual Certification
El Rainfall El Stocking El Crop Yield El120 Minute Inspections and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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 fait to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
0, l�o
❑ NA
❑ NE
❑ Yes
El
ElNE
ElYesrN
❑ NA
❑ NE
❑ Yes
4.
❑ NA
❑ NE
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? (ic/ 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?
Additional Comments and/or Drawings:
❑ Yes LJ' o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
rJ N
El NA
El NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

lType of Visit a 7Routine
pliance Inspection 0Operation Review Structure Evaluation Technical Assistance
Ir Reason for Visit 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 'j.y o5 Arrival Time: 33a Departure Time: County: IM14143 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f r r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number. -
Latitude: [= o = = Longitude: 0 0 = 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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 I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Neifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Li No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑o ❑ NA
El NE
❑ Yes
El Yes
El NA
El NE
El Yes
❑ NA
Vo
❑ NE
12128104 Continued

Facility Number: 1
Date of Inspection !
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: �f T� cAA} 2—
Spillway?:
f
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ENo
❑ 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
3No
❑ 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 u 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 LJ 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 Area
l2. Crop type(s) es C. 6 6 J CL,}S MSLL ET
13. Soil type(s) fzASINS V�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
L'J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
wl�
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LjNo ❑ NA
❑ NE
.�l,) Tr-410sfr--c- UW9 �z�vo ' to �cz�c�c cL f6n-A'.'5.
Reviewer/InspectorName Via''17 Phone: (�'rloj %`Lb -7a6S
Reviewer/Inspector Signature: Date: S`1.;'Li S
IL/LV/VY I..VLLLL►i NGtl

Facility Number: 3 ( — 1 Date of inspection Zu oS
Required Records & Documents //
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [jNo ❑ NA ❑ NE
the appropirate box. ❑ Wp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
E1 Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking Ercrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,L'
No.
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
64
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DIN,
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
LdN0
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U<O
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E 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
ETNo
❑ 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
El NA
El NE
33. Does facility require a follow-up visit by same agency?
Yes
ElL?
�N
o
❑ NA
❑ NE
A¢dthonal"Comments and/or Drawings:: „` r
12128104

Type of Visit oCompliance, Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit '0 Routine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tune:
0 Not Operational O Below Threshold
AfPermitted 0 Certified
��[3 Conditionally Certified 13 Registered Date -Last Operated o Above Threshold:
Farm Name: County:.....//
Owner Name • SW�7 �. Phone No: _ ...
Mauling Address:.._
Facility Contact: __W_ _ ._. .. _ _ _ Tittle:.____ fie' ,,�,0. )-74 t- --Phone No:
Onsite Representative: &Ac�� In_tegrator.
Certified Operator:
Location of Farm:
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Norse Latitude ! & u - Longitude "
F
o Feeder
to Finish
to Wean
to Feeder
Farrow to Finish
11 Gilts
Boars
irrent � =�x Desk -= Cut
ulstion: Cattle �at9 `Pope
Other-
'
�'otsi'Dtsrgr Capacity
Diiscbaraes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo
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 part of the operation? ❑ Yes, '� o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )2'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 2rNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Stricture 6
Identifier:
Freeboard (inches): 7
12,112103 Cominued

acilety Number: — �j 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
0 Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
tZ
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefimprovement?
❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenance!'improvement?
❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
El Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenanmrunprovement?
❑ Yes fi�No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes XNo
❑ Excessive Ponding ❑ PA15 ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
S�7
12. Crop type � e ��GGEI
13. Do the receiving crops differ with those designated in the ed Animal W Managemen Plan (CAWMP)?
[I Yes ;YNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes XNo
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 IJ No
16. Is there a lack of adequate waste application equipment?
❑ Yes 9No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;ZNo
roads, building structure, and/or public property) 1
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes pJ No
Air Quality representative immediately.
c c i ta1.4II st= Nanswm
�m
Use dr8vvtags o!'+far�tty Lo bsttrr,plam �lattoas. (aye add'ittonal pages neoessaryr Feld Co ❑ Final Notes
i
=� F� �o
6� �f � 'ram/J��-U ��+(/Gi�� !.�/L .ram` S ��/}s�% �7
©G!!�✓F� Q ,' �'�
A.
Il
I1n v fcTrzto� F,9-,e �.4F_FBoRa �oGf}r f jl�zT,-� �.ECeX�S
3.5)
t 1jel 4 ;/4:�M
My
Reviewer/Inspector Name%�'F <
Reviewer/Inspector Signature: Date:
12112/03 r. v Continued

Facility Number: — Date of Inspection
Required Records,& Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes j No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ 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 9No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes )ZI No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ON.
27. Did Reviewer/Inspector fail to discuss reviewimspection with on -site representative? ❑ Yes No
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 ONO
NPDES Permitted Facilities /
30. Is the facility covered under a NPDES Permit? (1f no, slap questions 31-35) Yres ❑ No
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 ONO
❑ Stocking Form A Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
l2/l2/03

Type of Visit 1Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit VRoutine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: OrJ
18 Not O erational 0 Below Threshold
Permitted 0 Certified © Conditionally Certified 13Registered Vate
�LLaastt Operated or trove Threshold:
Farm Name:
Owner Name: _ _ �/Qf/�op, Aa,�kFPhone No:
Mailing Address:
Faeility Contact: Title: Phone No:
Onsite Representative: ir�iQ%�✓r� _�9,ew e lc Integrator: -,�f1�2 5�
Certified Operator:
Location of Farm:
Operator Certification Number:
�ffswine ❑ Poultry []Cattle ❑Horse Latitude 0 4 " Longitude 0 6
Design Current
nwme Capacity ro Matron
❑ Wean to Feeder
El Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current Design Current .
Poultry Capacitv Population Cattle Cavacitv Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray -Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
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
Strwtu e 1 Strucjur�e 2 Structure 3 Structure 4
Identifier:Ila
Freeboard (inches):
05103101
Structure 5
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure
Continued

Facility Number: - Date of Inspection G '
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 1. Is there evidence of over applic ion? Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type `ZA-ZE 1. 11�Vl) iY�_,0-7- em-5.
13. Do the receiving crops differ with those desi n ted in the Ce ified Animal aste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XI No
❑ Yes P(No
❑ Yes 01!'XNo
No
❑ Yes
❑ Yes ip(No
❑ Yes IeNo
El Yes !VNo
❑ Yes 0 o
ElYes 1[No
❑ Yes No
ElYes 4,No
❑ Yes o
❑ Yes YJ No
❑ Yes 0No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Cl Yes
❑ Yes
❑ Yes
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to qu n i # Eaplaua any YES nswer nd/or any recommendations or any o her comments. }.
Use drawings of faciliiy to better explain situations _,(use addrt onal pages as necessary) Field Copy ❑Final Notes
zy .
Reviewer/Inspector Name
Reviewer/Inspector Signature: adndL Date:
pfNo
o
0N1
�No
YNO
�No
�No
�dNo
gj'No
05103101 1 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?
Additional Comments and/or Drawings:
7a
Of
05103101
❑ Yes ❑ No
❑ Yes No
El Yes 2'No
❑ Yes ❑ No
❑ Yes ONo
o
ElYes
❑ Yes ❑ No

Sg� T
Type of Visit _OCompliance 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: 7 31 Di Time: !(I S
� 1 %, 2
0 Not Operational Q Below Threshold
Permitted 0 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: , �O
.1514*......`.J4e 4rCdfW 1'e.....�.c...... .....r`!r'M � l County: V���
Owner Name: ..............t:.T:uyd.:.e..... T.'LrC�!l..e........................................................ Phone No: ................................................................................
.�:.
FacilityContact: .......................... ............................ ........................ Title: ........................................................ I....... Phone No:
MailingAddress: ........................ . ...................................................................................... ......
Onsite Representative: Is'G>'re... '.�GL��.......................................................... Integrator: , I'/�' !!! ,`tea."4'd... .....
Certified Operator: ................................................... .......... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° A& Longitude • 9 44
=._: Design '- Current Design Current Design Current
Swtne -capacityPo ulation . . Poultry - -Ca ad . Po tilation ' Cattle Ca c� Po eiistiaa
V Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish 10 Non -Layer 1 ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder IF] Other -
Farrow to Finish Total MsiCa aci
Gilts
❑Boars Total SSLW�
Number: of Lagoons F T ❑Subsurface Drains Present ❑ Lagoon Area . ❑ Spray Field Ares
m.
Holding Ponds / S61id Traps' ❑ No Liquid Waste Management System -
Dischartres & 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?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................�.............................. .z.............. ....................................................................................................
Freeboard (inches): 3 3�
5100
❑ Yes PNo
❑ Yes,,ffNo
❑ Yes No
l�
❑ Yes No
❑ Yes�No
❑ Yes �o
❑ Yes dNo
Structure 6
Continued on hack

Facility Number: 3/ — z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes )7(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes EfNo
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 maintenancelimprovement?
❑ Yes xf No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 0"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes /EfNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 'Ef No
11. Is there evidence of over application? ❑ Excessive PondingOPAN ❑ Hydraulic Overload
'Yes ❑ No
12. Crop type Fe—,,. t v e Calfor✓ zP fn W �1 ea� o e ,(
13. Do the receiving crops differ with those designated in the Certified Animal aste Management Plan (CAWMP)?
❑ Yes ,,,ZNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes ff No
16, Is there a lack of adequate waste application equipment?
❑ Yes Q�N0
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ONO
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�fNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ErYes ❑ No.
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ja'No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes PIAO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ YesB'No
24. Does facility require a follow-up visit by same agency? ❑ Yes J2rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �o
Q viafiQnjs;e�- defc}encies v+re P4>te� �liH`ilrlg ��is.��s�t� Yoh'}�� ><eeejYe �#ou;thgr
comes' o deike: abauti this visil:
Comments (refer to-questiop If) .Explatu eny YES answers aud/or any.:recommendations or',any otlie> cammeafs. �,
_:.
Use -drawings of facility_ to better, explain situa ons. (use add>ttiional pages as necessary) - '
P 'P�° 9 tiou,Se �o la1aoi, o� � ..
B. ►Urged �o � �'il ! op, e Ltct � o�.r ��'or+� Z s;-{e
�1 1 l ems, Wqf some 3_r,jg1j 4• 0011- 0-' 0verafpi1'Lg-h,, 01'Pfilll om4ke 2D00-2o0 j
-leS&ue crop on 0 A few.)00lrf. 1
l I. Need 4o 6v k U s e q waste q na�Y s� s da f ed t-';41t,'&1 dv_? �
ctffl;c4lroh eve�n4s op, Ike �it'Q- Z1S,6e sure -�, � eLla��c � Q-Z�s Foy
►'►')R� ��p1� o�-�,'�s 4o `7belhs "4 `&R- J ^e tpaS4e qn'l 1 y5,.s ;,r vsed.. —
l
Reviewer/Inspector a SfohGz✓R
Reviewer/Inspector Signature: Date: .? 1 0 5100

FacilityNumber: —/ JoZ Date of Inspection ? 3 P
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes',2T-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? ❑ YesATNo
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 JVNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,[3No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional- Comments an or Drawings:,:-
1 9. 6l Sd�P 6� �l�e KKR- Z's sG�d� �a�,-� cs q .ece;
���s oar: AYiI beans ire l��-fe� ►� maw cro �;el� ;�Lla�. e �2j�-2s
46 S�jDL�/ Sa b�Ghs w, � QOIpYopr,4�c �NI� 41 �Cl''�`tYl C2.
7 fl
0-f cire
5/00

nA
Dtvisiyn of Water Quality x ;�
�.
x 0 Dtvrsion of Soil and -Water Conservation ..: '£
Type of Visit RCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: d G Time: 3 d Printed on: 7/21/2000
Facility Number
Not O erational 0 Below Threshold
`Permitted (] Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
FarmName: ....��....... %........................................................ CountF=:..._�L�.............................. ......................
OwnerName:.. .......................................
Facility- Contact: .....
Flailing Address:
........... Title:
Onsite Representative:.�J. . .......... ................
CertifiedOperator :................................................... ...
Location of Farm:
....... Phone No:........
Phone No:
........................................................................................... ..........................
Integrator:.....cCcSi.:................................................
........ Operator Certification Number: ..................................... _...
L
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude + ° i° Longitude C • ° 64
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder ❑ Layer I I ❑ Dairy
Weeder to Finish J❑ Non -Layer I I I[] Non -Dairy
❑ FarroW to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Tots! SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lags•on Area. JE1 Spray Field Area
Holding Ponds / Solid Traps 1 1[:] No Liquid Waste Management System
Discharges & Stream Impacir
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge oridinaied at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. 1f discharge is observed, did it reach Water of the State'? (if yes, notify DWQ)
[] Yes
❑ Na
c. 11" dischargc is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
14No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
N0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure I Structure 2 Structure ; Structure 4 Structure 5
Structure 6
Identifier: ....................................... .........................•
Freeboard (inches): Q
5100
Continued
on back

lFaciliity-Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes JkNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes NO
(If any of questions 4-6 was answered yes, and the situation poses an ✓
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes '(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes bdNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes tRrNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes �fNo
11. Is there evide a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )ZNo
12_ Crop type . G tJ VCJ`f
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?
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?
Oe/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
: N(j-yiolatioris;ot• deficiencies -VI k.rh6fed-dtWing 4bis;visiL • ;Y;ou will-reeeive iid further • ;
.. corres�ondeizce.about.this.visit.�.•.�.-.•.-.•.•.•.•.-.-.•.-.•.-.•.-. ...
❑ Yes No
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ru-No
❑ Yes 9No
XYes ❑ No
❑ Yes �fNo
❑ Yes XNo
❑ Yes )ZNo
❑ Yes �No
❑ Yes WNo
❑ Yes XNo
❑ Yes r9t4oN
❑ Yes JX'No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
v- '
a� o3 c l IL
A.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
0-31 �3gad
Date:
5100

Facility Number: — 7a Date of Inspection a 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 SJor 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 peimanenJtemporary cover?
❑ Yes �No
❑ Yes �No
❑ Yes No
❑ Yes �No
❑ Yes 0 No
❑ Yes �No
❑ Yes KNo
5I00

© Division of.Soil and Water Conservation Operation Review
U Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality - Compliance Inspection i
Other -Agency Operation Review
ID Routine 0 Complaint- 0 Follow -tip of DWQ inspection 0 Follow-u of DS%VC review 0 Other
Facility Number late of Inspection L 99
lime of Inspection LL1L�J3I 24 hr. (hh:mm)
1�bPermittcd fia Certified [3 Conditionally Certified [3Registered E3 Not O erational Date Last Operated:
Harm Name: ........t.�. C....1111., ��Q T.4..�.P.�SeL4....`�.1... ��...... County:..... \�la...................
Owner Name: •......................... .......... �� \ ..... Phone No:..... (nj!?l Z`� .`. g 4t.................-........
FacilityContact: .............................................................................. "title: ....... ......................................................... Phone No:
Mailing Address: ........�.Ct ....J t�c......... .... ....... ...� 1La-LUT... !........................................ ..Z�.... �..........
Onsite Representative: �1 .....�..-..Inte-rator- .....
�)t, ,..............................................................
Certified Operator: ................. rA)11-'.r......... k�... ..... Natt.......................................
Operator Certification Number:..... ........................
Location of Farm:
r....................................................................................................................................•--...--.----.........................................................................................................................t
Latitude Longitude �• 0` ��° -- —
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish (A ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity T�
❑ Gilts
❑ Boars I Total SSLW
Number of Lagoons ®Subsurface Drains Present ❑ Lagonn Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharttes & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes Pj No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes M No
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes Q1 No
c. if discharge is observed, what is the estimated llow in gal/min?
d. Does discharge bypass a lagoon system? ❑ Yes [5� No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 10 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 7'
Freeboard (inches): ............
1/6/99 Continued on back

acility-Number: I — I Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
ld. Are there any buffers that need maintenance/improvemenl?
11. Is there evidence of over application?
❑ Ponding
❑ Nitrogen
12. Crop type .............................. tsw.e................. cze ............Ww
..........
.4`:�IIaQG�,......
❑ Yes'
[YNo
❑ Yes
tR7No
❑ Yes
9bNo
❑ Yes
',No
❑ Yes
Wo
❑ Yes
`® No
❑ Yes
," No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes RNo
14.
Does the facility lack wettable acreage for land application? (footprint)
El Yes
V No
15.
Does the receiving crop need improvement?
❑ Yes
V9No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
NJ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Wo
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
q No
19.
Does record keeping need improvement? (ie/ 'irrigation, freeboard, waste analysis & soil sample reports)
IA Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
I$ No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
?No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
qNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
�: NA.violations :or. def cieneies .were noted. during .Niis.visit:. Y.ou wdl.reeeive no further . • . :
• 'OrresWHidehee: abiAt: this visit.: :::: ::::::::::.: ::.: ::. ...........
Comments (refer to question #): Explain any YES answers and/or any recommendations'or any outer comments
Use'drawings of facility to better explain situations. (use additional pages as necessary):
��� Ee o�. 5� re c o►d� �{ t'� dam. itihsre ^
V�COAOL'v- )0 �Scaa � T-OLJTI�-) se' -Um C_CAKj
y,k.3\e�`�(s�s
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5 �
Reviewer/Inspector Name _L-
Reviewer/Inspector Signature: �A
Date: > // G
1/6/99

[] Division of Soil and Water Conservation Other Agency
® Division of Water Quality
Routine O Complaint - O.Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3! Time of Inspection 006 24 hr. (hh:mm)
U Registered 0 Certified © Applied for Permit Permitted 113 Not Operational Date Last Operated:......-..,
Farm Name: ............ ....Uj. ........ VrC�?.4.... x �.... Yir�... �'fr' Z County: ..A iv ............................................... .............
Owner Name :..... >�....... Q.t:t:ui........................................................................... Phone No:
....`1!Q�...4.'.R`�r.............................................
Facility Contact:.., �.;5�4t ................................. Title: ..... Phone No:
Mailing Address: .... igq%-...... CaL....... rip.ry-.s......... U............... I............. ...
t
Onsite Representative:...... iL......P.i m .......................................................... Integrator:....Avqby...:?... iL�k...6......
�s1ia�1�.�.....
Certified Operator;
Location of Farm:
............................................................. Operator Certification Number.......�..................
....o...... C'&e... M.�................................................................................................................................
ft(A�-- S�t, o
..._ ..... ...... ........................................................ 7
Latitude • ' " Longitude ' =1 " -
v. Design . Current aDesign Current, Design Current
SV.,,me ' "° CapacttynPopulabon' PotilEty Ca acit Po elation Cattle
p y...a.,.p M. ,rCapacity" .'pula#ton
❑ Wean to Feeder ❑ Layer ❑Dairy F.
E Feeder to Finish % i 0 10 Non -Layer I ` ❑ Non -Dairy
❑ Farrow to Wean'
' El Farrow to Feeder } ❑Other
❑ Farrow to Finish A Total De'gn Capacity Z?
❑ Gilts I
❑Boars Total'SSLW ��
r
;Number of Lagoons I Haldtng Ponds �Z� ❑ Subsurface Drains Present 1101,agoonArea ❑ Spray Field Area
�f ❑ No Liquid Waste Management System f
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
M No
2.
Is any discharge observed from any part of the operation?
M Yes
❑ No
Discharge originated at: ❑ Lagoon P Spray Field §1 Other
a. If discharge is observed, was the conveyance man-made?
® Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
® Yes
❑ No
c. If discharge is observed, what is the estimated flow in-aVmin?
ti
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
N No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
52 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5.
Does any part of the waste management system (other than lagoonstholding ponds) require
® Yes
❑ No
maintenancelimprovement?
.
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
[AYes
❑ No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[$No
- 7/25/97
Continued on back

Facility Number. 31 — ( L
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (I-ap_ootts.Iioldin Ponds._Flush Pits, etc.) .
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure '_ Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......-. .�..............................#1 ............... ... ............
Freeboard{ ) ft Z:................................................................. ......................................................................................................................................................
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?
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)
i
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 .......... G.Or.n.-------(.t la.t--.......SQ1................. �.11... ............................................................
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 AW,MP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
Yes
❑ No
❑ Yes
7 No
Yes
❑ No j
.............................................
❑ Yes
5 No
❑ Yes
P9 No
0 No -violations or deficiencies rvere-noted-during this,visit.- .You4ill receive no further
eorrespbndence ahout this'. visit'.,'.'..,
❑ Yes No
❑ Yes No
{� Yes ❑ No
❑ Yes 10 No
5Q Yes ❑ No
❑ Yes ® No
❑ Yes 19 No
❑ Yes ® No
Comments.(refer,to question #): Explain any YES answers and/or any recommendations or any oilier comments � �
Use drawings ,facility to better explain situations.'(use additional pages as necessary).
I ( 1 tt �ou i
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1
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O, 60W J4sla+O,
0.,Ml
f�#. Svaalf; of wp��l4i 3. 7/25/97
r
'So; � �ji' -.R j 1XA_Gn 5 0 h C t w
h tlfd
Reviewer/Inspector Name
JA
Reviewer/Inspector Signature: - Date:

T,
0 DSWC Animal Feedlot Operation Review
DWQ
Animal Feedlot Operation Site Inspection .... ..... .
Anme-
xx­
140 Routine 0 Complaint 0 Follow-up of MA10 inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Farm Status: E3 Registered El Applied for Permit
fA Certified [] Permitted
Date of Inspection
Time of Inspection L_111_. �o 24 hr. (hh:mm)
Total Tithe (in fraction of hours
(ex:1.25 for I hr 15 min)) Spent on Review
or Inspection (include-, travel and processing)
113 Not Oper Date Last Operated: ................................................................................................................................................
Farm Name: ......... "_41f ...... ?uA& ... T;.M. . ....... +A-z- county . ...... b4in .............................................................
.....................
OwnerName: ....... lrv.t�h-A_.G......?.u..[}�f................................................................... Phone No: .........................................
,ritle:.........QWA I W. 0 . ................................... PhoneNo-
Facility Contact: ......... ........cu ..... I .......... .. OIMP51.773M . ..........
MailingAddress . ....... L0.41 ...... C.au ...... . rank-5, ..... (U ...................................... ........................................ ...... I......, . ..........
Orisite Representative:.......... KA. r . ..... ....................................... -A.r Integrator: ....... tAuyib�f .........................................................
Certified Operator:................................................................................................................ Operator Certification Number:..... ...............
Location of Farm:
I,. �nur ... ......... A.
uul - fA
15A. - -
M�
a r--- —1. r I., 6r, !SR 1 X16 L�r, 1.
a I At I 1 11 wr r t�-!i on
cleff).
Type of Operation
Design Current Design Current —Design Current
A-" Swine Capacity Population-'. Poultryn Capacity'.. Population Cattle Capacity 'Population
El Wean to Feeder
%Feeder to Finish
L k Lg
El Farrow to Wean
[:1 Farrow to Feeder
IEI Farrow to Finish
d Other
. . ....... . ........ . . ....... .. .
Umberof Lagoons H61difig Ponds Subsurface Drains Present 110 Lagoon Area [PSpray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at., El Lagoon El Spray Field El Other
a. If dischart-ye 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?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
Z�
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?
4/30/97
El Yes JR No
0 Yes gNo
C3 Yes JO No
❑ Yes No
tj
❑
r
Yes CM No
0 Yes 'M No
El Yes �`o
0 Yes f6lo
Continued on back

Facility Number: AlZ
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La oons and/or Holding Ponds)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4
3 ............................3...I.............................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed? .
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste .application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
;KNo
❑ Yes
R No
❑ Yes
'ONo
❑ Yes
NJ No
Structure 5
Structure 6
❑ Yes
$&No
❑ Yes
§a No
;;Yes
❑ No
15. Crop type ................S.G ?.t..................... ........................................................eayleans...................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
IT 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?
For Certified Facilities Onto
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes K'No
❑ Yes ,9 No
❑ Yes 5'No
❑ Yes 19 No
❑ Yes & No
❑ Yes 19 No
❑ Yes 54 No
❑ Yes ,g No
❑ Yes R No
❑ Yes ®.No
14Yes ❑ No
17-• IKLa - Pt eS 6p% IOW 4-1 56UId be, �e) r1 in a5cof� ecod Wded
r. s 1no.,c C �,� ytU e M, 111rur UU, 0 01, 1 arsn 4f4 SiwvN be~ Mxoej.
axca_s ©� abitl 9f' Z Scovfa J. b7- 41t,. Ih iv—
c�_ °�
14, s ?r" tc,ay�s s �l<�a �� a��� . u�aa� sod oA%J wo.,�k. aAaIy Iris 5 s 6ull
b%-- tr CA -WARP. qa(J #- sGvooO L6 tAeW ay-, s mods.
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4liU/91

Facility Number.
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Dater 19
Time:
General Information: . y ae
Farm Name: County:
T
Owner Name: i A e- Phone No: z T .�7 3*`r4
On Site Representative: 5� - Integrator: J'hyaQ�ioGt
Mailing Address: 1 O'f F;--f-b ev0•
Physical Address/Location: I T 1y 4 d- ..� �.
Latitude: I 1 Loneitude: I 1
Operation Description: (based on design chamcterisbcs)
Type of Swine No. of AnimaLs Type of Poultry No. of Animals Type of Cattle No. of Animals
Q Sow ❑ Layer a Dairy
❑ Nursery ❑ Non -Layer ❑ Beef
Weeder 2Z4F4( C Z)
OtherType of Livestock Number of Animals:
Number of Lagoons: (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Yes1d
No ❑
Is seepage observed from the lagoon?:
Yes ❑
No$I
Is erosion observed?:
YesZ-
No ❑
Is any discharge observed?
Yes ❑
No IN�
0 Man-made Q Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes ❑
No @l;
Does the cover crop need improvement?:
Yes ❑
No C�
( list the crops which need improvement)
Crop type: /-o �1� Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes ❑
No`EI.
Is a well located within 100 feet of waste application?
Yes ❑
No A
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
No&
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
Now
AOI -- January 17,1996

Maintenance
Does the facility maintenance need improvement? Yeses No ❑
Is there evidence of past discharge from any part of the operation? Yes-0 Nakci
Does record keeping need improvement? Yes ❑ No1R
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ . No @
Explain any Yes answers: , ALC Cv �S . �? VT
Signature:,_ _ _ _ _ _ _ Date: ,,3` 4V _5q6
cc: Facility Assessment Unit Use Attachments if Needed
Drawings or Observations:.
AOI — January 17,I996

Site Requires Immediate Attention:�
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: �� f C� ��AW
Mailing Addrnit
County:
Integrator. Phone:.
On Site Representative: Phone:
Physical Address/Location:
I'l6� It
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEAN Certification Number: ACNEW
Latitude: ° ��' Longitude: 7° l •$" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Yes r No Actual Freeboard:' Ft. I he$
• Was any seepage observed from the lagoon(s)? Yes PWas any erosion observed. Ye r No
Is adequate land available for spray? Yes or No Isovcrop adequate? Yes or 1 0
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellingsEYes, ik No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land appliedor spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
.similar man-made devices? Yes EEO)
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: &4 Ag[ %Z lq_
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.