310216_INSPECTIONS_20171231

Idm
NUHIHUAHOLINA
Department of Environmental Qua

Itype of visit: (dCom ance Inspection C) Operation Review C) Structure Evaluation 0 Technical Assistance
Reason for Visit�Ro�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �) Departure Time: County: Region:
(pJ�J" Farm Name: /i7 �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
0,Int(7\..kL� it
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
can to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Desigu Curreut
Cattle Capacity on.
DairyCow
Wean to Feeder
Feeder to Finish
Farrow to Wean
09
q
Non -La er
I) . P,oult , �
Layers
Design
Ca aci
Current
P,o ,
DairyCalf
DairyHeifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCow
Other
11 Other
Turke s
Turke Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes []No ❑ NA ❑ NE
❑ Yes [:)No ❑ NA ❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes 0 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 7 - 2 t (o Date of Inspection: 7
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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _3 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 t real, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes2�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 or ❑ 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
<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[jNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
En'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
ffNo
❑ NA
❑ NE
Reauired Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LJ IN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather. Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E:f 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 21412015 Continued

[Facility Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
C3No
❑ N
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
nc (use;additianal nsbec as necessarvl.
Reviewer/Inspector Name: lam/ � 0 Phone: kQ-q16 73a
Reviewer/Inspector Signature: ,�/ Date: ` l
Page 3 of 3 21412015

Il'ype of Visit: (O Cotlipliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: rj S KQ Arrival Time: Rl= Departure Time: ) (7 County: U Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: W4 &-'MesoP) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 11 �L+D
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I 11-ayer
Design
Capacity
I I
Current
Pop.
IDai
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I INon-Layer
I I
IDai
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , $oultr,
Design
C_a acit
Current
Pao ,
D Cow
Non-Dai
I Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E,14
❑ Yes ❑ No
❑ Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes n o ❑ NA ❑ NE
❑ Yes U1 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: -9=0 jDate of Inspection: b`
„ Waste Collection & Treatment
1a. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �L
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 O/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVNcc
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 r 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
qqq ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LJ 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes V ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Ins ection: j JOLVI
(1,74. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
No ❑ NA ❑ NE
EJ/No DNA ❑NE
❑ Yes ��No
No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes EKO ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes U""o ❑ NA ❑ NE
❑ Yes
E2<o
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
o
❑ 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 lase additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phon"
Date4;tS
2/4/20I5

(Type of Visit: ©'Cotllpliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 7 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:l(O/JQ/IS I Arrival Time: Departure Time: D_�00_a County: .✓U T Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 9"t�j SsavVWt'j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 11 DPQ
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
jDairyCow
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) UylUpIt ,
Layers
Design
Ca acit
Current
P:o .
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other ir
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
ZNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
LJ N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412015 Continued

lFeWility Number: - Date of inspection: &I (o t.5
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1. A &,,,, � u 1 0— Lk —no Z -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[—]Yes No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2"No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[Z No
❑ NA
❑ NE
Yes
. .�#No
❑ NA
❑ NE
❑ Yes
[�'o
❑ NA
❑ NE
❑ Yes []11�o ❑ NA ❑ NE
[—]Yes E�(No ❑ NA ❑ NE
❑ Yes l � o ❑ NA ❑ NE
❑ Yes uu1No ❑ NA ❑ NE
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes Nc ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifily Number: - Date of Inspection: - 1
24. Did the Facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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 LCJ " ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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 EI/No ❑ NA ❑ NE
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes I__I 1Vo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
ER o ❑ NA ❑ NE
[3,N/o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orany other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
IS') t„/6E_-D CPIXM'0Z. NEC.DEU
Reviewer/Inspector Name:
Phon(_ I{ 1
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Type of Visit: Q C�o/q�pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Ld Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:© Departure Time: County: DwaL Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: SGRnI �Mao/v Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 17 270
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultay
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry P,oulti.
Layers
Design
-a aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Torke 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 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
[:]Yes [-]No
[—]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes [-]No ❑ NA ❑ NE
[—]Yes L�J ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3
Identifier: UMMO LLOW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L4
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[:]Yes LZ/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application 1111
10. Are there any required buffers, setbacks, or compliance alternatives that need El o ❑ NA ❑ NE
maintenance or improvement? 7
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L.Q o ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
J 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
[�
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes Vo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ 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 structures) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA NE
Other Issues
— /
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
I ISO ❑ 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
Io ❑ 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
[Q,11'o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
4
❑ NA
❑ NE
Comments (refer to question ta): Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain situations fuse additional paves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon �Q s
Date:
1

(Type of Visit: Q Co Hance Inspection U Operation Review Q Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O ComDlaint O Follow-uD O Referral O Emergencv O Other O Denied Access
Date of Visit: $ 1 'rj Arrival Time: Departure Time: ID / 5 County: _ 1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: C-PaJ &i AfgX4S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: tr12gb
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
10) P,oult .
Layers
Design
Ga aci
Current
P,o
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
—TurkeyPouets
Turkeys
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ N
❑ Yes Io
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: �,1 -'.IIL Date of Inspection:
Waste Collection & Treatment
4.-Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(%D-"_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a7 �` S
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[—]Yes No ❑ NA ❑ NE
[:)Yes Zwo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes � o ❑ NA ❑ NE
8. Do any of the 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 [jj'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�J/No ❑ NA ❑ NP
❑ 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 Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes I�Ip
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes V-' " o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ET� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 2
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection: ) I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Io ❑ 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 CAWNIP?
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 [I/No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
[—]Yes El"No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
F❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or, any other comments. I
Use drawines of facility to better explain situations (use additional paces as necessary). _
Reviewer/Inspector Name:
Reviewer/Inspector Signature
i ?v
r Rtr
•' i
Page 3 of 3

I ype bt Visit: (9 CCopliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Others 0 Denied Access
Date of Visit: lZ Arrival Time:® Departure Time: County: `JV� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: SCMVJ SUM?SUN
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: I { 212b
Certification Number:
Longitude:
Swine
inish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
We eeder
Q
Non -La er
DairyCalf
Finish
Wean
Feeder
Finish
n7FFeeder
Design Current
I)r$oa1�+ Ca acimP,oCa acit3m
La ers
DairyHeifer
D Cow
Non -Da'
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
101 Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impact
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 0 No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ o
❑ Yes wb
❑ Yes [✓o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: 3 - a.((o Date of Ins ection: g L
WasteCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ 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:,Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q6 33
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
7. Do
or environmen
1 threat,
notify DWQ
any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
✓ NNo
❑ 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 PNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CON/o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [2rNo
❑ Yes
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑lio ❑ NA ❑ NE
❑ Yes [�Io ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2 �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: (Z-
24. Dili 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 [3] No
tht 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes FZ/No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
Yes ['/No ❑ NA ❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑NE
Yes
E�o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Usedrawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: (d —72OA
Date: $ Z
anon

Dmston:of Water Quality r; "4„. , ., , �;-+,`•
i FactbtyNumber` 31 I n!�% rvtston of Sod and Water Conservation
O D1
n 4
Type of Visit (?(Co pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency (0�0th�er ❑ Denied Access
Date of Visit: FW311i Arrival Time: © Departure Time: /O 'S County: MO/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: c,. Title:
Onsite Representative: Sew SrI^'Zz'6
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o Longitude: = o = ,
I)estgn Current,.,, Destgn _gCarrent �D gnt Current
Swme Capacity
w.
Population Wet Poultry Capacity Population Cattle Capac Rty Population
t,,. •�.,,. •.�,.
.,_ ..
El Wean to Finish
_.
❑ Layer l ❑ Dairy Cow
r SO
Wean to Feeder
400
❑ Non -Layer
I
Dairy Calf
r
El Feeder to Finish
,.„ „-»."` �, *�. �•..,, ❑Dai Heifer
.w
— w• xV ': ❑ D Cow
w Dry Poultry
v
""' '" "�� Non -Dairy
El Layers � I ❑ Beef Stocker
•
,
❑ Farrow to Wean
;
❑Farrow to Feeder
❑ Farrow to Finish
„�
❑ Gilts
'� ❑ Non -Layers
❑Pullets
Turkey
❑ Beef Feeder
) ❑ Beef Brood Co
El Boars
z
Other :: _
❑ Turke Points
❑ Other
Numberpf,Structures:x_
❑ Other
I
IF
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 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ NN ❑ NA
❑ NE
❑ Yes
❑ Yes
L_/ ND ❑ NA
❑ NE
❑ Yes
17 No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

• Facility Number: Date of Inspection I 115 j_J
Id Waste Collection & Treatment ' ' -
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA&�&A ( LP'CyMrj Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0,0_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
VNo ❑ NA ❑ NE
through a waste management or closure plan? -
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
o ❑ NA ❑ NE
8. Do any of the stucmres lack adequate markers as required by the permit? ❑ Yes
❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
VNo
9. Does any part of the waste management system other than the waste structures require El Yes
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
//
E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
�J/
U No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
s
[RrNO
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
VY s
[I No
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
l� o
El NA
[I NE
17. Does the facility lack adequate acreage for land application?
El
146
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,
�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or,any other.commeuts
Use drawings of facility to better explain situations'. (use additional pages as:necessary):
o NEEDS To a Q£wl/E0, ARPZt- SsWC VATC. •
CAS,. �Bt N:11O0 1..1E E DS 1b ISE IaCAI CD . AC e-&v oTS
C.3rr-T os(�_ CAP-0.
Reviewer/Inspector Name vp., -. Phone: w(b
Reviewer/Inspector Signature: Date: S 3 11
Page 2 of

. Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes E/J o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
(/
ILJ 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 InspectionsEl
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ed 1 0
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
/[�/No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[JYes
Np
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Y/es
,❑l
L�J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
,❑,
L�'Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[a No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
_
LI o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes
Yo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o
❑ 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
ElLd 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?
[I Yes
[; o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
UNo
❑ NA
❑ NE
AdditionalComments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

31 H 2( b
Type of Visit (21 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (Ob0 Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: �� S�NtP�n� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: m o m' m« Longitude: M o M
Design Current Design Current
Swine - Capacity Population Wet Poultry Capacity Population
Cattle
Design
Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
1,LAM
oZ CXj
JLJ Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Dai Heifer
❑ Farrow to can
❑ Farrow to Feeder
Dry Poultry
❑ La ers
❑ D Cow
❑Non-Dai
El Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Turke s
❑ Beef Brood Co
Number of Structures:
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
WNtd ❑ NA
❑ NE
[]Yes QNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

rkacilityNumber:3( —�16 Date of Inspection N 1 b
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: iAC 2--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D oZ4
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
QNo
❑ 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 environmentalat,
notify DWQ
7. Do any of the structures need maintenance or improvement? El
El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
. /N/o
LEI 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 El Yes
,,(/
YJ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,�(/
T� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift (:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2rNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
B/N o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
.Comments (refer to question ft Explain any YES answers•and/or any recomniendations;or any other comments'
Use drawingsof facitity'to better explain.situations. (use additional pages`as necessary) � 2 _
p �
Reviewer/Inspector Name Phone: 16
.x
Reviewer/Inspector Signature: Date: 411110
�_.._ -11 12128104 Continued

Facility Number. — Date of Inspection t b
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 [I Other
❑ Yes 7No
o ❑ NA ElNE
❑ Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspectionss ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[I NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�u/No
L7 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EJ�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? -
❑ Yes
/N/o
Id No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[!o
;14
ElNA
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
L 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
O NNo
[I NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
EJ No
❑ NA
❑ NE
Additional Comments and/or Drawings: `
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Co
Reason for Visit C� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 $ a 4 Arrival Time: /® Departure Time: County: oUPl1Lr,I Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: $H>t.N S,ry psdoJ
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: = o = , = «
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 L1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31 — Date of Inspection
Waste Collection & Treatment
4. "Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes 11d 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: LAGod�J t IAGnsW 7/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �1-3
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
1
❑ Yes LEI No
[]NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L(/ 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 El Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10lbs ❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E!rNo
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
—3No
2No
❑ NA
❑ NE
Gc t S" W
ASAP.
IReviewer/Inspector Name I dl-j►,f }-AR L I Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Pacility Number: Date of Inspection 8 oR
Required Records & Documents 1
19 Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes �6No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes yf No ❑ NA ❑ NE
the appropimte box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[)No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain InspectionsEl
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
El NE �.
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EJ No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
U//No
[INA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L 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
�f
IQ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C?(No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
[:3Yes
WNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Hy
Page 3 of 3 12128104

Facility Number
to Division of Water Quality
0 Division of Soil and Water Conservation ,
O Other Agency
Type of Visit Co Hance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I -t I Arrival Time: IS Departure Time: County: DUPL-TN) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 34.taT m=mj4 co. Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o = ,
Swine
Other
❑ Other
.Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I ❑ Layer
&40 0 1 SS z 0 1 10 Non -La et
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current,
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
[INA
[INE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

94
I
IF4cility NumDate of Inspection
I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes w No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure
5 Structure 6
Identifier: CA(oan�l LA&ya,o �..
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ffNN [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
LQthNo ❑ 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
Q1<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
W/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
,.,//
L� No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
ff NNo
ElNA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
ElYes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[),
El NA
El NE
17.
Does the facility lack adequate acreage for land application?
[I Yes
,Xo
Ekt o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,Jb&D Ta Ge ColLrrCtJ I" :WC ercCrx-.).j,
Tpl.)
r_aVL0 V6I(sun r % 5t,U0c.E c-Ac
-10NE nws( vo SWO6E
14AD 20-07 OfC, CQWO W-r F-r),I(J FAX- tOey
fo U4j
Reviewer/Inspector Name o NU CKer4- l.l-
Phone: 9/o 7 F - 73
Reviewer/Inspector Signature:
Date: D
12128104 Continued

Facility Number.
Date of Inspection
Required Records & Documents l
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ DesignEl Other
El
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes I� NNo
❑ Yes E2No
❑ NA ❑ NE
❑NA ❑NE
n Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi'l tjttalysis ❑ Waste Transfers
El Annual Certification
El Rainfall ❑ Stocking [I Crop Yield ❑ 120 Minute Inspections u1Monthly and 1"
Rain Inspection�No
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V3 0
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
UJJNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
9"Y'es
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
E Yes
❑ No
El 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
N
[I NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
��
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
2 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
do
❑ 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 [INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Comments and/or
12128104

Facility Number `1j �
fp Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 6
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,Coolnpliance
VJ Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: �Arrival Time: /1 DO Departure Time: County: DuftXA% Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: SEW "tAfSOIJ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=o =. =" Longitude: =o=,
Swine
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
sh I I ❑ La er
ter I %�io o I Sy oo 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population `=
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ YesJo
❑ NA
El NE
❑ Yes
[�No
❑ NA
❑ NE
12128104 Continued

I'
Facility Number: 1 —
Date of Inspection 9 J 1
31aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[>'I�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA&aaJ i LAis"A/ 2-
Spillway?:
Designed Freeboard (in): 1 S , S
Observed Freeboard (in): 2g1
5. Are there any immediate threats to the integrity of any of the structures observed?
[IYes
Ld No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E5 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[
El NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[1"No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application ,(/
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes C No ❑ NA ❑ NE
maintenance/improvement? �,(/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
2-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
d Y
tes
"
CtNo
❑ 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
KNo
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
EJ1No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
IS.)
QEYVtO�E F2ovn
SIpE
a� FSCW I' 4
OF
Jt 0 DCGAYrr.)G FIA✓, ,
a�.
j
rAV COPY aC
UC,
ILfENst wL7H-EY0
30
apys
Reviewer/Inspector Name J 0461 FA ZU(-_GL Phone:( 794 3
Reviewer/Inspector Signature: 4 Date: J

I�
Facility Number: — 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 appropimte box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes dNo ❑ NA ❑ NE
❑ Yes IG No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
0"NNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IQ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,(;Ko
LGNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
LJ Yes
❑ No
❑ NA
❑ NE
2?.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
F_;rKA
❑ NE
Other Issues ,�—�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L J, o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
/
�,�I 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
J2<o
NA
NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or
12128104

M
y (2 Division of Water Quality
acility Number ` O Division of Soil and Water Conservation '
--- D Other Agency
Type of Visit Co pliance 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: WQ7 Departure Time: County: 111PLE0 Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S&AIJ S�KOA/
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
=" Longitude: = U =
Design Current ;.
Design Current
Design Current
Swine
Capacity Population Wet Poultry
Capacity Population Cattle^ Capacity;Population
❑ Wean to Finish
>- ❑ Layer
I
Dairy Cow
® Wean to Feeder
6q
b.
❑ Non -Layer
I
I
❑ Dairy Calf
",.
❑ Feeder to Finish
- ❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
-Da'
Farrow to Finish
❑La ers❑
Gilts
❑ Non -La ers❑
"Non
❑ Boars
Pullets
—
❑ Turke s
— - —
Other`
❑ Turkey Pouets
�.
,
❑ Other
❑ Other
Number of Structures',
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page t of
❑ Yes L1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
[I No
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
V�o
❑ NA
❑ NE
12128104 Continued

Facjji(y Number: — Date of Inspection
Waste Collection & Treatment _ //
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes I/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&oorN I (A6oml 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yy 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L/J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,(/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [n No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) N e"t/0A ( k ) Sir 0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes LI No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
s ❑1No El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El Yes Ef No ElNA [INE
17. Does the facility lack adequate acreage for land application? [IYes ;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 comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
Zl.)
SEfJD CoPMCS
4�
CnA9 YXCL-b to t7WQ (SY ENp M^aCN -IA06,
IS)
CoWKWQE.
%
Waft-tL on1 3�rJt w v DA GaIE r�
Reviewer/Inspector Name Phone:(970J 79t7 l74,5
Reviewer/Inspector Signature:. Date: 3// b/oli
Page 2

Pacility Number: — 2 Ip Date of Inspection le 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes an ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
E Y es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Week Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
El Annual
Certification
El Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2 No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
2rNNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
DNA
❑ 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
�❑
I� NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El'No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EK
❑ 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
�,�
Er 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
,�,/
B 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
E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L,1✓ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

FAX NO.
�i��1 `. �c���r�
Mar. 31 2006 10:49AM PI
RECEIVED
MAR 3 12006

a
O
Z
x
a
LL
Foam CRor-7
CROP YIELD RECORD
Farm Owerl Sean Slmsm
Operator
Facility Number 31 216
Date
mnVd
Field/Pull ID
Crop
Yield
Bales or Bushels
Bale Size
d a ficable
Field/Pull S¢e
wetted acres
*Yeld per Acre
Bale or Bushel/Ac
4/12/2004
1 & 2
sG
12
1800 The
8115r2004
1 & 2
BER
22
1800
a1312004
1 & 2
BER
32
'1800
312MIM
1 & 2
SG
11 1900
28 1600
9/8/2005
1 &
BER
. (3) Yield/Acre = (1) Yield divided by (2) Field/Pull Size. (3)=(1)/(2)
E
O
w
tl

Type of Visit grCompliance 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: D r eparture Time: tLL' L�f1m' County:
Farm Name: `�2.Sf� Fi�1/Y) $ Owner Email:
Owner Name: s c, G�AI �i%IPSO�✓ Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: iW
V%i4/vlys�� Integrator: /t-al�i2D
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Back-up Certification Number:
Region:
Latitude: = o = ' = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: - - ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EZJ
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 VJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
12128104 Continued

Facility Numb er:3 — N
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level
into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: J4(
A(V
Spillway?: NO
ND
Designed Freeboard (in): /9,
Ll '5
Observed Freeboard (in):
2
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;ZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;;�No
❑ NA
❑ NE
through a waste management or closure plan?
TTTT
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
(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 ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No
El NA El NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t6 No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Clop type(s) 6 62enZ49WIY�V
13.
Soil type(s)~'' / e f/{c(,
14.
Do the receiving'crops differ from those designated in the CAWMP? ❑ Yes ONo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes 'VNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes PNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? El Yes pi
El NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes XNo
❑ NA ❑ NE
zItt /t95 SOZG -7,�zX-r %?jF.pv27'
0 llaG NF�O
Reviewer/Inspector Name F—C 0 W� ' Phone:
Reviewer/Inspector Signature: IIZ* Date: &/Z/'9jr
Continued

Facility Number: — Z/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
VYes ❑ No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
C/LC
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sro�ill Analysis ❑ Waste Transfers El Annual Certification
EllyZ Rainfall Stocking 0 Crop Yield 10 120 Minute Inspections Monthly and V
Rain Inspections Vf Weather, Code
22.
Did the facility fail to install and maintain a rain gauge?
Z/Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
,❑jNA
l4 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes A 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�INo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 'WNo
El NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
TTT
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes '0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes �No
❑ NA
❑ NE
Additional Comments and/or Drawings:- •' , •, :. , , r . ,., •-;.:
.
"
/5 Cv�►r a/r✓f2 /moo /��,� FS�.¢zcGo Lit/
64� r
I�AJO
u�,¢-�E�>�o,✓,
Wi5 V. 5AO /ejy _009y— I2128104

iType of Visit 0Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: // Time: �Ls
O Not Operational O Below Threshold
❑ Permitted 0 Certified Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: . (._&Cf Cl Qr._. fin. _........................ .... —.......... County:... j��../........ __........ .......
Owner Name:.�l�l_lhlSGa!7 ................ Phone No: .... ....................... .
Mailing Address:
Facility Contact; .._._.............._............__........._......._._.__....._... Title: .......................... Phone No:
Onsite Representativert�_ Slrx�Pfr�ftiC./_!FIfG__.. Integrator: _ . - /'/S p�
Certified Operator:
Location of Farm:
Operator Certification
Rf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =K Longitude =• =' =11
to Feeder
to
to
to
Other
Discham & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struc/tt}tre l Swc g 2 Structure 3 Structure 4 Structure 5
Identifier: _.... •••........ _... _._...._ r/ _....... __...__.
Freeboard (inches): ^ `
❑ Yes O No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0Wo
❑ Yes
21go
❑Yes
lstro
Structure 6
12112103 Continued

Facility Number: - — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes X No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ;jrNo
closure plan?
(D' any of questions 46 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 'ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes )eNo
elevation markings?
Waste Aoulication
10. Are there any buffers that need maintenanceltmprovement? ❑ Yes ZNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ,eNo
❑ Excessive Ponding ❑ PAN
// ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type hl`e'n MOA (Nav S (r �t/if2Sf s0 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ) NO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes IoNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ETNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes m No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [IYes No
roads, building structure, and/or public property) )
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �No
Air Quality representative immediately.
1 O Field Coov C7 Final Notes I
15) -I,JI � STZ�c lJ� BEQMNo,9 fa�L,o�,
p�F�E�o mpesr- &e- Ae/nooeo '6y �IPRu
21) /1%60 aw
73)
gy et4,v? A srt rlPI,6,
,j Tyr .�aV l°4;eo �s� f F2 ice
rye
!�(.1w,5'e /OD Pao / 041✓Ia -
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

Fadifty Number: 3 / _ 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/ WIT, checklists, design, maps, etc.)
❑ Yes LR-Ko
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 ,!rNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ONo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes �No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
28.
Does facility require a follow-up visit by same agency?
❑ Yes `N No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes )dNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes No
1No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes ❑
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
ddiuonal
ZR IDG ° l/FR5F�0 ArF_ FJT �n/ �J° d2 � Z.
AP,
12112103

IType of Visit 0 Complianee Inspection O Operati n Review O Lagoon Evaluation - -
Reason for Visit ine 0 Complaint oll up O Emergency Notification O Other ❑ Denied Access
Date of Visit: /!i Time: / _ D
Facility Number
10 Not Operational OBelowThreshold
Permitted C7{ICe/trdfied 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: 1 Aa.A p 5 County: •1 "PLZtt)
Owner Name:Phone No:
Mailing Address:
Facility Contact: Title: 1 t���QPhoone ,No:
tJ OnsiteRepresentative: S [JS�/Y1P-50"). 2650r Integra,
Certified Operator: Operator Certtfrcation Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle
❑ Horse Latitude Longitude �• �• ��
--= Design'-
Current.. - ' -`Design -=.Current - -' " _ - .Design . -Current
Swine-'-' ` .' Ca atin•
Population -'Poultry- "Caacity Po ulation- Cattle " : - , Ca aeity Po ulation
— Wean to Feeti
der
❑ Layer " ❑ Da' -
Feeder to Finish
i; Non -Laver -: ❑Non -Dairy
❑
... ❑ Farrow to Wean
- - - -- - - - - - •
❑ Farrow to Feeder
_- _
❑ Other
❑ Farrow to Finish
3,Total Capacity
❑ Gilts
_
❑ Boats
• TotaI.SSGW'
Number of Iagoons R -,;�}
• .,� ❑Subsurface Drains Present ❑ Lagoon Area - ❑ 5 rav Field Area ;
- Suhd Holdi Ponds t Tra s'
aR' _ p ,' •;�
: �, ❑ No Li uid Waste Management System ".
Discharges & 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 gallmin?
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
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
rrAA
I� No
Structur 1- Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Structure 6
Freeboard (inches): 2
05103101
Continued

Facility Number: 3/ Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Aonlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN Hydraulic Overload
❑ Yes
❑ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Wa4NIanagement Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination? -
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comments(referto qutin #Explam
anyYES answers-anwor anyirecommedn
np�
Usedrawingsoffac0itytobetterexastuatns(useado
ecetsarv) Field Con+ ❑ Final
ruspasnEli_
LL:
.�No_tedpin
_
)/�
/ aot-0 49 vilvk_�-,70A-"144-�%D�°S 4G/' i✓Di7'-s7�il/ S2Tf
�t7 �ELP �=Ti%
FL'D/�lA'1F/✓psJ7�oi1%S 6�i✓��F,�//�it/G
U`
Reviewer/Inspector Name
-
404
Reviewer/Inspector Signature:W44L__Date:
Z2n4lp
0510310I ✓'
Continued

Facility number. —2 Date of inspection i/7A/7/phi,
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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
I Additional Comments and/or Drawings:-
/ 11r �%�Y�ni �T,✓ j/ eX�
F� Z not,
(14�67 L --r-
ppN�
?,00 I So�� FsT T�E�
0IJ L7rMF
I Ft S LAs'(
®01\F2 PLR,)s Teo RE�1- Sr IJ�,
Olt�t��2 I���PS 1 p QDCLIMr -r t c, /ri/'� 11� s ��
I �mPRDQ�E_ F�GL�s. C(Acc Nye W-�ErJ �-OK
VLRO 7V �2ZG
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
rO Not Operational 0 Below Threshold
0 Permitted O Ce red 0 Conditionally Certified [3Registered Date Last Operated r Above Threshold:
Farm Name: Q/T:vi=sue ARM< County: �YaL z/V
Owner Name: \'5'm/1% ._) . �G /�pSa /✓ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
�Qn�/-, ZTC//&G r Onsite Representative: �r .tCC(V1 ���� �m��egrator: I TOG�(%5�81Q�5
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' =` = - Longitude =' =I = u
Wean to Feeder
Farrow to Finish
No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ElLagoon ❑ Spray Field ElOther
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 ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: # ( it 7i
Freeboard (inches): 917 '31
05103101 Continued

Facility Number. 3 — 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 maintenancefiimprovement?
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 maintenancelrmprovement?
11. Is there evidence of over
12. Crop type
❑ Excessive Pending PAN
❑ Yes INo
• Yes /PNo.
• Yes {(No
D Yes (ENO
0 Yes ) No
❑ Yes F No
Hydraulic Overload j�yes ❑ No
- - - A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management
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 or other Permit readily available?
WMP)? ❑ Yes Olo
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 situationsias required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require.a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
❑ Yes ❑ No
0 Yes ❑ No
0 Yes ❑ No
XYes ❑ No
❑ Yes ( No
• Yes XNo
❑ Yes VlNo
❑ Yes XNo
❑ Yes No
❑ Yes VNo
Yes All
❑ Yes /No
XYes ❑ No
❑ Yes Ao
I rNo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. j

Facility Number: — Date of Inspection T�—
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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
o
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads,, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanendtemporary cover?
❑ Yes
❑ No
I naatnonat Comments anaror urawmas: _ , • . + . ` , s -, , . ., ; 1
,914 2oD/ � nJp z C'�f�a �� pn Foz LZM r <� 11l4r3
eal d JflC �f}GGFO . / F•/,L?ZG`�ZF,R !/�/4G�/� FiC �/�IE
y4,op��c 4: zoo
,D�DB�s�y N,� 7
C.Sy„
05103101 .

Division of Water Quality
�k! _ Q Division of Soil and Water Conservation
O.Ofher Agency
Type of Visit ik Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit V Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Z OL 'time: /1 .00 Printed on: 10/26/2000
Facility Number 2
Not Operational O Below Threshold
'Permitted 0 Certified ❑ Conditionally Certified E3 Registered Date Last Operated jjoor�r Above Threes►hold: .........................
C orwpii5 rv� S Countv:...........Dy /i.'� Laen
Farm Name: . ......................................................................................................................................
.................................
OwnerName:......
L.t..k....................��...``...._
._'�.........V.bet........................................
Phone No:.................................,
Facility Contact:
....... u`.^...............?..t
....... Title: .....
il.".:.'..N.: .............................. Phone No:
Mailing Address: ............................................................................................................... .......................
►'fin r ........................................................................................ ...
Onsite Representative:..YC.vL..._I,[.t .�_N._�_�...._ta n.._i• y... In[egrator..,_,J+S1�o! D.,.,._„t' �t,,,,.l
c... .........
Certified Operator:.............................j...:cet.•r.S.rr... ....................... Operator Certification Number:..........................................
Location of Farm:
'Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • =, =- Longitude =• =° =11
Design Current
3wwc
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Po ulation
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons I J I❑ Subsurface DraiaLKE!!!2LjILl Lagoon Area
Holding Ponds / Solid Traps E== ❑ No Liquid Waste Management System
J❑ Spray Fie�
I
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes �YNo
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 DW Q)
❑ Yes ❑ No
c. If discharge is observed. what is the estimated Flow in galhnin7
— //ff—
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes []No
2. 2. Is there evidence of past discharge from any pan of the operation?
❑ Yes Dy No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes P(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ............ �_.."�. ..... .I.........................�...•..................................... ..................................... ....................................
....................................
Freeboard (inches): tAp1.�2.hQJ'v
5100
Continued on back

Facility Number: — 'L) Date of Inspection O O
.y
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O'No
/nS�tructture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
6 ......1d ............... ..........C.V. !Ltd
.......................................................................................................................................................
Freeboard (inches): .......... a 3 ................
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?�fYes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
I�LYes
`
❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
*0
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over applications?? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Crop type A 1_�. _56 I
13. Do the receiving crops diffe[ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes A?FNo
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? '5(Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ;No
17. Are rock outcrops present? ❑ Yes ❑ No
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown ❑ Yes ❑ No
❑ On -site ❑ Off -site
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? `
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ;00
�No
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes22. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
23. Did the facility fail to have a actively certified operator in charge? ❑ Yes I �7 No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
1qdNo
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9'No
26.
Does facility require a follow-up visit by same agency?
X'Yes
❑ No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
Odor Issues
28.
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?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
01/01/01 Continued

07¢
Facility Number: — 2 t (p Date of Inspection o b d
30. is ther any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 1 /4/2001
❑ Yes 14No
❑ Yes CKNo
❑ Yes [XNo
❑ Yes I[,,No
❑ Yes) No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) Explain any�YES answers and/or any recommendahonsnr anyothe�r� ominenfs � � �—h X._;:
Userdrawings of facility to better explain situations (use additional pages as necessary) �-❑
Fteld Copy ❑ Ftnal Notes v'"
/S!JOldL CDvty- Crop n..,kSt be 'x+ wAl
`
toy' %�.a�o�dize��r. �,� �s�,1 L.o�s rke--s t-a
4pp1a(-osPez-
If vLl''
�' o«a+ � rvvV -6tFil g r, Z DD N
►��
�a a 4 �o Sa ti yam-
r eF�,,r - �-r-e U S s , <� o �o ,. w ',\ \ Y\.v-w
p, t r Vt— a'y?�
r,,� � nn pp 0� 3.01 atrtS rtV� }o SD Ids
(e]
�- Wup J
old
2 '�-V 11 ow - G(oY, GPs yev�evi -�-ejd
tiS 0. Cet� t�NIV" r� S Yu7
Reviewer/Ins ector Name ' ` %<• 5'R
P ,s... a
Reviewer/Inspector Signature: Date:
01/01/01

.Division of Water Quality
Q Division of Soil and Water Conservation
- - - - 0 Other Agency_ -
(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 �,� Date of Visit: -O -DU Time: � Printed on: 7/21/2000
Q Not Operational Q Below Threshold
E3 Permitted 10Ce '6ed�, ^13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .....n..................
Farm Name: ....................!f/!.5.............%.Counhrz................................... 5.:..........
Owner Name:......_. S/..' ....:-:.................................. Phone No:.......................................................................................
................................. a
Facility Contact..............PEE.N............... l..I'k >~.........Title.........1/. !. % .............................. Phone No:...................................................
Mailing Address:
Onsite Representative: ........h<,(,((),........._... p...!t`..............�.f�._" "/iY........_ klc Integrator:........... `Zv(�P.�.G..
Certified Operator:...... . ..............................v' . ...... ............. Operator Certification Number
Location of Farm:
Swine ❑ Poultry LJ Cattle LJ horse ""`^""` I I I ' I I""'""'^''-"
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po ulation Cattle Capacity Population
KL
Wean to Feeder
32,OD
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made' ❑ Yes []No
h. 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? jVl¢
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 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M_No
Structure I So ucttuuree 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ .3.0._i1........................4.Y.."....................................... ........ ............................ .................................... ..................... ...............
Freeboard(inches'):-�-r>m
u
S/00 � Continued on back

Facility Number: ?l-1,212,1 Date of Inspection -O(.- Printed on: 7/21/2000
5..Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes KNo
❑ Yes KNo
❑ Yes A No
❑ Yes XNo
❑ Yes XNo
❑ Yes j$No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes '5No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes %Io
14. a) Does the facility lack adequate acreage for land application? ❑ Yes []No
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?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0' �Vo violafiolis:ot, deficiencies were holed d,t ing -4his:visit; Yoit :will receive tie: further
coriesnotideike:ahou£this vlslt.::...:: .
❑ Yes ❑ No
❑ Yes ❑ No
N(Yes ❑ No
❑ Yes gNo
❑ Yes A No
❑ Yes 1[ (No
❑ Yes JZrNo
❑ Yes i,7'No
❑ Yes fa No
❑ Yes KNo
❑ Yes KNo
❑ Yes XNo
❑ Yes KNo
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):
/� ' ifil ii�l.,2J{ sLlvua h r ror�ravti�L �rnn-�,''{,laL //�w�-*/" as sin us c rdrfinrs'st/ -
O[tt' j • L1%r�. 6+� lw�/ Lon7Lr-o! it, Vr4 Gals IXY, sir 60'rtP1an5 7'n rC- /Vr j
'get"",
in Sp�rh c %0!7/, l
%�t°r/rii� �ra<<s5 i�2JJFv �taPole� 6e sin �v (� A%.
� 6ean ems, n %a�� loan Wield /Kars (Nu /u��,
r'ias,; ,yr //f - Zkd
Reviewer/Inspector Name b , rt f 1 e i� a���
Reviewer/Inspector Signature: Date: -�5100

r Facility Number: f Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ',,,___�/// Io
❑ Yes EXNO
❑ Yes VNo
❑ Yes kfNo
❑ Yes No
❑ Yes No
bona omments�an or rawtngs:- s - .a-
_ _ -- _ _.... _.... _ __ _ _ .. .. _
4vt �XS�

r,
_' • ' = []'Division of Soil and Water Conservation --Operation Review
Division of Soil and Water Conservation - Compliance Inspection
�Review
of Water Quality- Compliance Inspection r, -
OtherAgency- Operationevnew•
Routine Q Complaint Q Follow -tip of DWQ inspection Q FolloN% -up of DSWC review O Other
Facility Number oZ I Date or inspection
Time or Inspection tS 24 hr. (hh:mm)
0 Permitted Certified ❑ Conditionally Certified ❑ Registered C
Farm Name:..._1�:4...T................_............................................
OwnerName:....-.......1.`..J4!r.................................................................
Facility Contact:
Title:
Not Operational Date Last Operated:
Countv: t
Phone No:
Phone No:
MailingAddress: ............................................................................................................................................................. ....
Onsite Representative: ... . .................................................................... Integrator: ... Gc(d..
ma.....
........................ ............
..................-...........................................................................
Certified Operator: ................................................... ................................. 0 ........................... Operator Certification Number:..........................................
Locatiou of Farm: I _ n
Latitude =• =1 0•1 Longitude 0. 0' =..
to I
to
to
to
to
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons I e,4 JLJ Subsurface Drai!LKE!!!2LJjU Lagoon Area JU Spray Field Area I
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes C�,No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ANo
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes KNo
c. If discharge is observed. what is the estimated flow in gal/min!
d. Does discharge bypass a lagoon system? ❑ Yes 9No
2. Is there evidence of past discharge from any part of the operation? _ ❑ Yes KNo
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 ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 9
Freeboard(inches): ............. 3....._......................._I ...........................................................................................................................................................
1/6/99 Continued on back

Facility NumbDate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes N No
(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 'ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
[XNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
,�/
lg No
11.
Is there evidence of over application? ❑ Pondina ❑ Nitrogen
El Yes
V(No
12.
Crop type.t!7..'...f.._............................ ...................................`.................................... ......................................................................................................................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
[]Yes
'RNo
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
gNo
15.
Does the receiving crop need improvement?
❑ Yes
ONo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
JANo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
N No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Oyes
XNo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ERNo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
(NNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[�No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[X,Nc,
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
P- No.violations or. deficiencies mere noted during this visit:. You will.receive no further. .
ebrrespor... e. abbot. this :vis . ..... ...... • ... • ::. • ... ....::: ::.. .
Comments (refer to question #): Explain any YES answers and/or anyrecommendations-or any. other comments. -
Use drawings of facility to better explain situations. (use additional pages as necessary):;_ -
Luwz� \c fc.�
ReviewerAnspector Name
✓e�IIkvE� g(�s per '"CsjKs e (f
Reviewer/Inspector Signature: _> (_ _f\ Date:
1
IN

.y
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection
Facility Number I Time of Inspection 6 O 24 hr. (hh:mtn)
0 Registered CClertifiedS 0 Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated: ..........................
Farm Name:.......\..nf ...................................................... County:..... ............................
�/../ .........................
OwnerName:....... - ....Sl.r` 5.......................................................... Phone Vo:......�.1...1... A7.....pp...._...1................aa......................._.
Facility Contact: ��'�I,, few
.................. Title:................................................................ Phone No:...............
Mailing Address:
......A& I... . .......ems .......................
OnsiteRepresentative: ..... S...J.xw..�i...................................................................... Integrator:
Certified Operator........ ...........................................
Location of F
Operator Certification Number, .........................................
.koxtrcFdS....1!^`.-+ r.... �...45 ..�....... �. / ..:'S [!� _. r...!S 4 i......1 h.....�
.l.�....Gl..... \ ......_.....Q.2....w..!�n................�....,.Sal`................................................... .
J
Latitude 0•=,0" Longitude 0.0'0"
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IXNo
2. 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 0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes V(No
c. If discharge is observed, what is the estimated Flow in gal/min? #r
d. Does discharge bypass a lagoon system? Of yes, notit_v DWQ) ❑ Yes 64 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes P9 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 lagoons/holding ponds) require ❑ Yes ONo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [XNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes DI No
7/25/97

Facility Number:
• 8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons,Holdinp Ponds. Flush Pits. etcJ
9. Is storage capacity (freeboard plus stone storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard (tt): ..........d r ............' 0.,3 .............................
10. Is seepage observed from any of the structures?
❑ Yes b(No
❑ Yes 10 No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or enviromnental 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 off WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ._, 4N.._ ...{...5�'................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0- No.violatioitsor deficiencies were noted during this:visit. You.will receive no further
ctirrespblidebce EOout this:visit:
❑ Yes ONo
❑ Yes 9No
I,Yes ❑ No
❑ Yes gNo
❑ Yes [RNo
❑ Yes b(No
❑ Yes CgNo
JaYes ❑ No
❑ Yes ) No
❑ Yes No
❑ Yes No
[Yes ❑ No
❑Yes 0&0
❑ Yes O*qo
❑ Yes JXNo
la) SkA;&.ze ber.,v_ owe, 4l5 ll oo-j rek,-e,4(
toe" 1.e�
��yz(1Satl C (��e(U
K�F1'v'11I � 2 \r/5 rY-Q +`�,
�tG C�!P1eS C�1� YP�c.ch� ✓PVtGnr�c �-, OWC1 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: f I ��N Date:

,(❑ DSWC Animal Feedlot Operation Review
j® DWQ Animal Feedlot Operation Site Inspection
w
.� .,
IQ Routine 0 Complaint 0 Follow-up of DNA'Q inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection LiWA7
Facility Number ,3
Time of Inspection El= 24 hr. (hh:mm)
0 Registered q Certified E3 Applied for Permit E3 Permitted JE3 Not Operational Date Last Operated:
FarmName: ....... �Lai).iSC....... KarhiS........................................................................C:ounty:....... �J��in..................................... .......................
u�Owner Name:.......... �f........ .,? OTSalo...................................................................' Phone No:.L�� �. 1..�o J �.'._4l �.....................................
Facility Contact: .......... c_.��+TT..........J.i.N'S)pin........................ Title: .......... 01+ittip...................................... Phone No:..S...gI.R�.%5-�%iiy......
Mailing Address: ...... 13.1........Vf....... N(31Q...... 1-41VIL............................................... .......:�.-....�.I:1!e...I...NL..................................... � 4 .......
Onsite Representative: .....�AYI........... 5Tf11DSt9Ys..................................................... Integrator: _..60((�6.0.......!'Dfr:......
............
.....
....
.............
Certified Operator: ......5.C4.n........1,.......�;.txt1 p unt................................................. Operator Certification Number J:......1 ZLSO..................
Location of Farm:
Latitude 3S •Fi7, Longitude ©• 57 L7
- Design Current
.Design Current
Design .Current
$wine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
® Wean to Feeder
JEI Layer I-
❑ Dairy
❑ Feeder to Finish
❑ Non-Layer
❑Non-Dairy
❑ Farrow to Wean
E3 Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity,
(.,`fob
❑ Gilts
M Roars
Total SSLW
14? LLnn
INumber of Lagoons/ Holding Ponds JEI Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area , I
No Liquid Waste
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes Ul 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 Surface Water? (If yes, notify DWQ) ❑ Yes IN No
c. If discharge is observed, what is the estimated flow in gal/min? ---_-J—
d. Does discharge bypass a lagoon system? (It yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes J9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes KNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes Q No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 1R No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Dd No
7/25/97 Continued on back

1i9cib[y Number: 3(—LI G
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lasoons,HoldingPonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structme 2 Structure 3 Structure 4
Identifier: ..........�l ................. ............_#.. Z.......... ......... ........................... ......... I...................
Freeboard (ft ........... :. ...............................
..................................................................................
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 of 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
[ No
❑ Yes
No
Structure 5 Structure
...............................................................
6
.................................................................
❑ Yes
® No
❑ Yes
No
10 Yes
❑ No
❑ Yes
® No
❑ Yes
® No
15. Crop type ................ bPrvItj. a,..............................................................................................SA I....c} P4A........................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes allo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violationsor deficiencies wm noted during this.visit..You will receive no further .
correspondence about this visit.
❑ Yes MNo
EKYes ❑ No
❑ Yes No
Yes ❑ No
❑ Yes Do No
ZYes ❑ No
❑ Yes J•No
0 Yes ❑ No
❑ Yes t4 No
IZ- 130TI.(6 Ocns S6VO lx lywWd. �f e 4+eas oh (agt�oh uk (ls sWJ 6- vr4uet%d•
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7/25/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:, 1995
Time: b
Farm Name/Owner:
County:
Integrator: v Phone: �-
On Site Representative: 51� V\ Phone. -
Physical Address/Location: -wry-
/s o ly
Type of Operation: Swine ✓ Poultry _ Cattle
Design Capacity: 2,2,00 Number of Animals on Site: c:7, ,9, D D
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3' S " Q[' Longitude: % Z` 677_Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year24 hour storm event
(approximately 1 Foot + 7 inches) t5or No Actual Freeboard: -3—Ft. (:�- Inches
. Was any seepage observed from the lagoon(s)? Yes oCIF9 Was any erosion observed? Yes
Is adequate land available for spray? e r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: Q
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? 6s or No
11
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o<S�
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 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)? 'es r No
'gee&
In ctor Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.