310278_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: (j Cpliance Inspection V Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 1 a j Arrival Time:® Departure Time: SO County: �JPCJINJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative:�AIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: _ ��m
Certification Number:
Longitude:
Swine M I
Wean to Finish
Design Curren#
Capacity Pop.
FLa
Design Current
Wet Poultry Capacity Pap.
er
Design Current
Cattle Capacity Pap.
DairyCow
DairyCalf
Dairy Heifer
Wean to Feeder
Oa
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design C*urrent
i) , P.ouI Ca aci Pia -
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
I Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow:i__
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 o
❑ YesWNo
❑ Yes WNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: Date of inspection: 1tj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2f 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: (A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LAD
5. Are there any immediate threats to the integrity of any of the structures observed? LJ Yes n No L! NA
(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
waste management or closure plan?
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes / o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [3 Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo [DNA ❑ 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 CAW MP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
WNNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
b/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ 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
hTo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
QXo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

�1
acili Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes FE/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesgNo ❑ 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
[21/No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
Z(No
[�r`No
6/No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Edam any YES answers,and/oranv additional -recommendations or, any other comments _
wa.a.
Ilse_ drawings of facility; to `better ei<plairr situ'sttons;f use�addtteonahpa�esas nece_ssaiy).:
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phon(
Date: O
21, /20l S

Type of Visit: 0 rRoutine
pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
isit:
Reason for VO� Comps Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: L L1.LJ County. 1DVFW Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ��j� NA91) oN1 Integrator:
Certified Operator: Certification Number: Z f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I I Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D . P,onl Ca aci P,o ,
I Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ No
❑ Yes Ef�No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA [] NE
❑NA ❑NE
Page I of 3 21412014 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 ❑ NA. ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
cq 6rvi��
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 16 No ❑ NA ❑ NE
[:]Yes in/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment reat, 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? [—]Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes U(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes C,_j/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EP,4 ❑ 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 [7No
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes u 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 rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes /No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes UK<0 ❑ 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?
24. 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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0Io ❑ NA ❑ NE
ZZ
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E2<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes C2 1"o, ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 614 ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary}.
Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
d 11J 6 Phon/ d - 3 P9
lure:Cdc Date: q/y 1jjj
214/2 l5

Type of Visit: & ZRoutine
pliance Inspection V Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time:I�Lc i Departure Time: Q= County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
� 1
Onsite Representative: k-j 0� HAft 1s0r�1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 "7 111
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry C+apacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to FeederI
JNon-Layer
I El
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current.
Dry Pooutt . Ca aci P,o
D Cow
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turke s
Turkey Poults
10ther
Dischartes 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
[DNA
❑ NE
❑ Yes WN
o ❑ NA ❑ NE
[:]Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection: 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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ;`No ❑ NA ❑ NE
waste management or closure plan?
threat, notify DWR
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm;"Vo
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?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop 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
No
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rN
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 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 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2 y
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [/3 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes vo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes 2fNo
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes r�N'o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to'question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional oases as necessarvl.
Reviewer/Inspector Name: Phon b !
Reviewer/Inspector Signature: Date: l
Page 3 of 3 21412015

1✓
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: � N� �Nwoo ('N IL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 0 5211
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Pou1try Capacity Pop.
JLayer IDairy
Cattle
Cow
Design Current
Capacity Pop.
Wean to Feeder
(}
Non -La er I
Dairy Calf
Feeder to Finish
Design Current
D . P,oult . Ca aci Pia
Layers
Dairy Heifer
My Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkex 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)?
❑ Yes E3 /No [) NA ❑ NE
❑ Yes
❑ No
❑ NA
[:]NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? —]Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number:
Date of Insection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
dNo ❑ NA ❑ NE
[-]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3(0
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 � ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[—]Yes [�Xo ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes l d 0 ❑ 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 ON. ❑ 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
[D, o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑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
rNoo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: ylk I
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
�2
to ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
2 �No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA ❑ NE
Other Issues
/Ngo
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
2 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
/No
29. 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.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ZNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW -MP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FNo
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional Daees as necessarv).
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon
Date: (1
21412011

(Type of Visit: � Co�ipliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: CJi Routine Q Complaint Q Follow-up Q Referral O Emergency Q Other t) Denied Access
._.
Date of Visit: 3 t I Arrival Time: v o Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �p14A 9Aft:r5orJ Integrator:
Certified Operator: Certification Number:
Bach -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
oil
Swine
Design ...Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current11�
Pop.
Design Current
Cattle Capacity Pop.
Wean to finish
La er
Dai Cow
Wean to Feeder
aladJ
QSS*o
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
D P,oult s
Design
Ca aci
Current
P,o
D Cow
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Other Turke Poul#s
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes rNoo ❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: - a Date of inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes UNo
a. If yes, is waste level into the structural freeboard? [:]Yes [-]No
Structure I
Identifier: UV_vaa N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-!9
❑NA ❑NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [7'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
❑
7. Do any of the structures need maintenance or improvement?
❑Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
�] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Fa/No
❑ NA
❑ NE
Required Records & Documents
No
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
FD/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 ] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes qNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 1j -01'? Date of Inspection: 3 I S
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes rNo
J ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �❑ 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 [3] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes <o
❑ Yes ET<o
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
No
NA
NE
[
❑
❑
❑NA
❑NE
V
NA
❑ NE
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or. any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).,.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0
Phone: - -I 7'
Date: rl/
21412011

31 IMI an
(Type of Visit: Q Ccliance Inspection U Operation Review U Structure Evaluation U Technical Assistance " I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Z,p Departure Time: lt7 10 County: LOL* Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: -Jc> 4&3 "AdLb-r_<�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
eanto Finish
Wet Poultry
La er
Design C►arrent
Capacity Pop.
Design Current
Cattle Capacity Pop.
Da Cow
ean to Feeder
k
Non -La er
Dai Calf
eder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oultr.
Lavers
Design C►urrent
Ca aci P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rNo❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E70 ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faeili Number: l - ale jDate of Ins ection: l
�✓
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U 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: LAGO6J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
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? ❑ Yes LJ o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZN9,
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes [:3"']No ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
ElYes %%% Io ❑ NA ❑ NE
[] Yes �KNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes � ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Other:
❑ Yes YNo ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility -Number: 31 - Date of inspection: 1 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 POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ 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 VNo ❑ 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 Zf No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes : "" ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesFE]
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use. additional pages as necessary). .:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: It`L27/
21412011

Type of Visit: aCompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 6 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lb 2g Arrival Time: Departure Time: I173a County: DL)PLZ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: )014N HAP_Dx$ON
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1") 7-11
Certification Number:
Longitude:
Design Current
ean to Finish
Design S - -,
ltry Capacity Pop.
La er
I 1H0jjE0EjLD_esj2nzwU_,urrent
Cattle
Dai Cow
Dai Calf
Dai Heifer
C►apacity Pop.
ean to Feeder O
a QS
Non -La er
eeder to Finish
roars
arrow to Wean
Design C•El
urrcut
Cow
arrow to Feeder
I) , P�ouitr, C•_a aci_ Plo
Non-Dairyarrow
Beef Stocker
Beef Feeder
to Finish
La ers
Non -La ers
Pullets
ilts
Beef Brood Cow
Other
other =§1
Turkeys
Turkey Poults
10ther
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)?
❑ Yes n No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: io It
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: U4�15�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t4 Z
Structure 2 Structure 3 Structure 4
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
Structure 5 Structure 6
❑ Yes 16 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures sack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
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 rl/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 Q o
❑ Yes
[:]Yes [ No
❑ Yes E�No
❑ Yes F3/No
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
ljhfo
❑ NA
❑ NE
0 Yes
[3No
❑ 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 d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes �rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: jDate of inspection: (p IN I IA
24. Did thz facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 [Z"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes [J/No ❑ NA ❑ NE
❑ Yes
U�o
❑ NA
❑ NE
❑ Yes
Yes
E'<VNo
❑ NA
NA
❑ NE
NE
❑
❑
❑
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other, comments:_;, .�
Use drawings of facility to better explain situations (use additional pages as necessaryj:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Id ! f b — -7 3 44
"'
Date: l 2 �11 T
21412011

Division of Water Quality L
Facility Number 3 _ c�^Tg 0 Drv�s�on of Soil and Water Conservahon°"L
�.;OfherAgency
x.c. ♦ r , . .. .. . .. ._ . ^ . . .. .. r. ,. .- �. . — _-.:.�.,.._.,�,. _.�..m.......�M.., .. Ewa+ _. � .....�...,..==:;'+���. .:...i+4�►
Type of Visit 0 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ETL Arrival Time: lU3o Departure Time: County: Q19(T.t,Z Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facitity Contact: Title:
Onsite Representative: R A" :( t,d
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = [ Longitude: 0 ° =
- : Design -Current Current-
_- Swine Capacity ;:Population Wet Poultry:'Capaeity Population
❑
Wean to Finish
I JJD
Layer
Wean to Feeder
a(p4U
S l)
]❑ Non-Laye
❑Feeder
to Finish
h 1) Pc►ult
ry �, rY
�,
_
❑
Farrow to Wean
❑
Farrow to Feeder
Layers
❑
Farrow to Finish
min : • .
J Other
❑
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pou its!
❑ Other
tle
y Calf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood C
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 LI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
[__1 No
❑ NA
❑ NE
ElYes
EJ No
❑ NA
❑ NE
❑ Yes
EjNo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Date of Inspection li �-
Facility Number: 31—a.'1$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ONo ❑ NA ❑ NE
Structyre l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: GIQD
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental t}lreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
[1] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[I 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
ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes
E� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[3No
❑ NA
❑ NE
.Comm ents r 7.. e
efer to ueshon # Ex lain an YES answers and/or an .recommendations or an other, comments.
(q ): p y �, y
Use drawings of facility to better explain situations. (use additional pages as necessary)
ErF
7
Reviewer/Inspector Name 0�7' r4RrJ61.�>, , , '��'� Phone ��p����a �7�J
Reviewer/Inspector Signature: Date:
Page 2 of 3

Facility Number: ?) I —algl Date of Inspection 11 I L
Required Records & Documents //
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes D No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EdNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other 1
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IJ",No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[] No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I,.JNo
❑ NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
6 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Li No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
b No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
dNo
❑ 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
allo
❑ 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
ENo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
�/
E� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[No
❑ NA
❑ NE
Additional Comments and/or Drawings: q
Page 3 of 3 I2/2VO4

Type of Visit Q) 9"Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 0 1 Departure Time: County: CQ Region:.
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: �� u is e.02 s
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = [= Longitude: a o =
Design Current
Design Current
EDesjgn Current
Swine
Capacity Popula#ion
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
® Wean to Feeder
JE1 Non -Layer I I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
E]Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
El Beef Stocker
Gilts
❑Non -La Non -Layers
❑ Beef Feeder
EBoars.
ElPullets
❑ Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El NE
El Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page I of 3
12128104 Continued
Z

Facility Number:
Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes JNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): U
-o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes efNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L ,}�N ❑ 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 �f
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes L2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Flo
❑ NA
❑ NE
16. Did'the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[ "o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E.5,Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E dxo
❑ NA
❑ NE
Reviewer/Inspector Name 1.1 ,' Phone: 0 l3�!$
Reviewerllnspector Signature A,�, JA-tJ,/ Date: G
12/2R/l14 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 VNo
❑ NA ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
,E2
0! No
❑ NA
❑ NE
❑ Yes
Ek<o
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAW -MP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
el No
❑ NA
❑ NE
❑ Yes
EJ No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
r21z&1da

F
pe of Visit 7Routine
pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistanceeason for Visit 0 Complaint O Follow up 0 Referral () Emergency 0 Other ❑ Denied Access
Date of Visit: UOU
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: 3 O Departure Time: County:
Owner Email:
Facility Contact: r�T_-ittllje::
Onsite Representative: , A
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = 6 = Longitude: = ° = 1 = «
Design Cur, rent
Design .C•urrent
Design Current
Swine Ca aci Po elation
Wet Poultr• @a aci Ro elation
Catfle
Ca aci Po elation
❑ Wean to Finish
IEJ Layer I
I
Dairy Cow
Wean to Feeder
I
1 ;91SSz7 I
ILI Non -La et I
I
Dairy Calf
❑ Feeder to Finish
I MISS
Dairy Heifej
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
10 Beef Brood Co
❑ Turkeys
Other
Ell urkey Poults
❑ Other
ther
Number of Structures:
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rvo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
I2/28/04
Continued

Facility Number: — Date of Inspection SOS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes U1 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structur 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 0
Spillway?:
Designed Freeboard (in):�/9,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [3 No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
��
ElL�J 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? (Not applicable to roofed pits, dry stacks and/or wet stacks) El Yes 2-No ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes ha No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement? ,�
11. is there evidence of incorrect application? If yes, check the appropriate box below. El Yes B<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 Drifl ❑ Application Outside of Area
12. Crop type(s) COS
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
EI�No
❑ NA
❑ NE
No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ yes
[�
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNp
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
�_ P_Kk MJ tJ l2CGo p-06 (Ao 11-- Cab .
Reviewer/Inspector Name .6140
�} l.'° Phone:
Reviewer/Inspector Signature: Date: & S s­
12128104 Continued

Fircility Number: 31 Date of Inspection S o
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LQ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (NNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
0 NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑
UAA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�zo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[�iA
❑ NE
Other Issues �
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes 0 lVo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ 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
ETNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
No
El No
El"
❑ 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
LJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drauings: ,
12128104

Type of Visit QIffompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit jOrfoutine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number Date or visit: I
,OP-ermitted,,fftertified © Conditionally Certified © Registered
Farm Name: .,� �._.__.�.�....
Owner Name • _ _ ...._ ,._ ,
-Madmg Address:..
Tune:
10 Not Operational O Below Threshold
Date -Last Operated or Above Threes
County:
Phone No: r� _
Facility Contact: _ --Title: .. Phone No:
-'^
Onsite Representative:.��1
..��_�......�....r.. %aI�SVlqh'tegrator:.. _...........
Certified Operator: _ _._ ... . _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Pouttry ❑ Cattle ❑ Norse Latitude Longitude ' C Ou
Discharees & Stream Ln�acts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach 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 .,EMo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes .ENNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes _12.M
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
I2/12M3 Continued

Facility Number:3/ Date of Inspection C� P
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ofio
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Ef—No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes eNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �No
elevation markings?
Waste Application
10_ Are there any buffers that need maintenance/improvement? ❑ Yes ,rNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [21 No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 1. _ Len'ez . �; 5- %
13. Do the receiving crops differ with Illose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Z
o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J2Wo
b) Does the facility need a wettable acre determination? ❑ Yes 0%
c) This facility is pended for a wettable acre determination? ❑ Yes ffNo
15. Does the receiving crop need improvement? ❑ Yes 0No
16. Is there a lack of adequate waste application equipment? ❑ Yes J No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes 4jzNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 43INo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Yo
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 41f4o
Air Quality representative immediately.
---- '� � '��-� +mow: ,. r,.�'s�— :-��. ---w � _:..�;.-•; ,.� �.r-'s � ��..m -r�r� �^ } � -s
�Com� (refer to:garshoa�l#} �Eacplam a�ryYES�aaswas and/or<aaya �.. .. ar aay�other aa.� �-�-
Use drawer of ise ty�to bet�Mder; lain simatiaas. {nse add neary) 3❑Field Copy ❑ Final Notes
�as
//_�/�//:J���J 1+'�_
'51
00
Reviewer/Lmspector Nance _ a.� �S�' OR
ReviewerAW Spector Signature: Date: za
12112t03 1 Condnued

Facility Number: , 7 Date of Inspection D G
Respired Records & l7ocuments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,,®`No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,E:rNo
G�
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ 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
P*fqo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
O No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Freeboard problems, over application)
❑ Yes
;'No
27_ Did Reviewerfimpector fail to discuss review/inspection with on -site representative?
❑ Yes
❑i 'No
28. Does facility require a follow-up visit by same agency?
❑ Yes
CWo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Flo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35)
❑ Yes ,Q'No
31 _ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ 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 farther correspondence about
this visit.
,6/' S/oc1✓' Se�7'�rJ�i�Pi- �C'7l/�
12112103

of Water Quality
t
';
YY,
O Divrston of Soil and Water Coreservation
Agency.
Type! of Visit -Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .eRoutine Q Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit, l 4 f7 Time-- � 3: !(� Printed on: 7/21/2000
�� 2r?
_ I O Not Operational Q Below Threshold
0 Permitted ❑ Certified 13 Conditionally Certified l] Registered Date Last Operated or Above Threshold: ...................
�e i a County: .V'9 ,.h
Farm Name: ....... ................................................................
� kj^
OwnerName:............ °.....................�'rd �SDs'1..71............................................ Phone No:.................................................._....................................
FacilityContact: .............................................................................. Title: ................................................................ Phone No:
Mailing Address:
Onsite Representative: �_� n �^1a+ rd i fort � 74/Ir1 144iSQrij� Integrator.._,M.v.� ...h
.................................................}............_.._............I_.................._................._......I...........
Certified Operator: ................................................... ....................................................... ...... Operator Certification Number :......... ............. ....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �« Longitude �• ��«
Design Current Design Current Design Gbrreat
P' P`ulationCo
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
nwZ Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
's Boars Total,SSLW
❑ Subsurface Drains Present 1 ❑ Lagoon Area ❑ Spray Field Area
No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... i....... ........... _..................................
Freeboard (inches): 3 `1
5100
❑ Yes gNo
❑ Yes ONO
❑ Yes ONO
Ih to
❑ Yes ONO
❑ Yes J�'No
❑ Yes XNo
❑ Yes 'VNo
Structure 6
Continued on back

lff
Facility Number: .7I — Zr] Date of Inspection 2
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes JQ 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 jZrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P'No
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes J�(No
Waste AwDlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes PkVo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes J;3*No
12. Crop type C c r• Yt K e-q -, 5 o y b en h s
13. Do ihq receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EfNo
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettabie 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?
o yigia�igns'ee delfeienues were �ott'ddi�ring his:vlslt� Yoi>t will receive d fui-thgr
• coraresp denci al)6 ii this visit ............
❑ Yes ❑ No
❑ Yes ❑j No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes ONo
❑ Yes ,dNo
❑ Yes ❑ No
XYes ❑ No
❑ Yes j2'No
❑ Yes ,�rNo
❑ Yes 0No
❑ Yes j2fNo
❑ Yes Fi No
❑ Yes..01No
lti • Yaa need 4,9 5e-} 4e 1"4 stow len)A5, wl'd4l, A.
04' 4-Hr•ow, O'e'al &"rl gv,$)leJ )C4 r_ SL,pt-V jleL,,j We-&4 GiCecr19e
was c(e4ey r--%; „ea( aid keel w ;44 4e mcords .
/Vetd 4Q A. I ec^+ 4l,t intE01 edo r � 0% P�A rat0 rlerl;4 ) 0n)'14ro1icc� I ►`.s`f �.
rece rds ..SILOL / 31 "ti- cats av► 614 ftab t Aid 4(,rl o►\
g�►1/et . -7-L.cre Q-e ha 7I-r; ct4jo, evePk-�s Shaw ;1 4 k e rrec6,ds
a c Lpw n i �'v � - � x 1 eve t �� G"e . r►'j r . P1c? rvi ti o ii skiy s -;E (can-l; .1 Jed)
ReviewerAnspector Name #9
Reviewer/Inspector Signature:
D Z 5100

Facility Number: Date of Inspection i Z QZ Printed on: 7/21/2000
Oilor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Ff 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 JZNo
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 ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional'Comments andtor ravvrngs:
t9,�e�rl.};nue -j-�,e �'�reeboctr-� "cad.•-J P"us4 v�-- bwin r-ece1-ded
No4e: "'4e Plo,., oq?Iot..'S 1D/0 lbs. ?,ON/AC'C on 44e whea�
No-ie: Tl,c l S�a� hots ��cj J; d� -f're� barsr0� o �' 25 inc�es
5100

�Uivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit xcompliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: V')—GG rune: �� Printed on: 7/21/2000
Facility Number
Q Not O erational 0 Below Threshold
[3 Permitted 0 Certified © Conditionally Certified 0 Registered Date bast Operated
or Above Threshold: .....................
G`� G� ""t ...............I. ................ County:........}1�:- ��
Farm Name: ......................... S.......................................... ........... '�.. k:. ......................... ....................
Owner Name: .......
Facilitv Contact:
............................................... Phone No:.......................................................................................
MailingAddress: .......................................................................
Onsite Representative:... uv Sys
.............................................
Certified Operator: ................................................... ....
Location of Farm:
Title: ................................................................ Phone No:............................. ......................
................................................ ........................... .---- ...... ...................
`1- ...... .......-....... ..........................
.................................. Integrator:........ t^Ir1A..".?.........................................
............................................ Operator Certification Number: ..........................................
A
w
[]Swine []Poultry []Cattle []Horse Latitude ' 4 &. Longitude • 4 «
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons [E]Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impactti
i. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/ruin?
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 1�'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes *0
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes O(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... .................................... ................................... .................................... .................................... ....................................
Freeboard (inches):
5100 Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity, of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
KNo
closure plan?
❑ Yes
(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
kNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
NNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
CB�No
Waste Application
O(No
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
10 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�dNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ONo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
U(Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
�fNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
MNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
18. Does the facility fail to have all components of [he Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
t�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21- Did the facility fail to have a actively certified operator in charge?
❑ Yes
J'No
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
&No
Oe/ discharge, freeboard problems, over application)
❑
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
D'1slo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
D;'No
K'6.*iolattgris:ot. deficiencies *ere noted- d(Wift 1his:visit: - Y:oit will -receive •rio further
corres}ioridence: about thus :visit ::: ::::::::::: :::::::::::::::
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):
we GLGv�S, qV
Reviewer/Inspector Name
ReviewertInspector Signature:
3c(s-3700 X-aa6
Date: t lra--Ca 5100

Facility Number: Date of Inspection a Gt} Printed on: 7121/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aaor bielow 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 KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes bNo
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 EYNo
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 XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes tgrNo
taona Comments and/or rawings:
5100

'= Division of Soil and_C -Wateronservahon_ Operation Review
DEAsion of Soil and Water Conservation Complranee Inspection
Djnsion of Water Quality Compliance Inspection l __
0.Otlier Agency -' Operation Review. _ L _
Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection GG
Time of Inspection 24 hr. (hh:mm)
© Permitted Acertified [3 Conditionally Certified [3 Registered JE3 Not Operational 1 Date Last Operated:
1'1 d , 3
Farm Name: ... 4: '7n...L...---. .......... ...-.---- County......_ t :)..C�.(.,.1.-1�..-•....................................
Owner Name: �e.. .t'a......t i-[ i 2- -�. .�.�l..T.....�_............. ... Phone No: �.. M. .....2-a.. .�....Q ..-..1� 1
Facility Contact: ... `�.1 �Y11k�� r.........................................Title:.. ;.�V1.4 ..-��. .................. Phone No:
Mailing Address: ..�.....i..��.i ..N.I.n..&T-.0la........ .I. .L........ I
Onsite Representative: J.011.0........�..L.S�#`l..t.....sT1�-.s...... Integrator:'111��.L;..,..P.....1-k.Y..................................
Certified Operator:,z._.Q.t.A.n................ S.'011 r cZFt- Operator Certification Number: ...,„4 iQ �_........
Location of Farm:
... 11..-x S..t ....1... .Q.,......L�-Q......3.. .......Q.n.....5.-..1.L.5.0.........T.U..r a.......
IT.......T�..t'1..�......00.... b......5.. H..L.I .. 5..... (y..t ..... .i .� .T........ .......
Latitude E� • L. 1 ®. Longitude
-- - - -Design Current
Swine„ - --Cauacity Population
Wean to Feeder
Q
❑ eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
lNu tuber of Lagoons ❑Subsurface Drains Present ❑Lagoon Area 10Spray Field Area
Holdiing Ponds'I Solid Traps =` ❑ No Liquid Waste Manage
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 XNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes -KNa
c. If discharge is observed. what is the estimated flow in gaUmin'? ✓� /
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) El Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J<No K\
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........za.11............. ......... ............................I...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 'XNo
seepage, etc.)
3/23/99 Continued on back

Facility Number_3l --Z, Date of Inspection
6. are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-5 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 maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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?
Nd •yiotatiogs :oi•• def eienues -were noted. diWirtg �this:visit; Y:otr 'WHI-reeeive iio further
c6rres�6yideirce. abouf this visit.. .. • .. .. • •
Comments (i deer to�question #) " E7rplain any -YES amwers'aidnd/or any recommendations`or any other comments:
Use:drawings of facilrty to better explain situaboits [tyse additional pages as necessary)
❑ Yes ` KNo
❑ YesNo
❑ Yes gNo
❑ Yes "KNo
❑ Yes �No
❑ Yes �No
❑ Yes X
No
❑ Yes Vo
❑ Yes XNo
❑ Yes VNo
❑ Yes P(No
❑ Yes )�No
❑ Yes *No
❑ Yes U-No
❑ Yes trX
No
❑ Yes No
❑ Yes gNo
❑ Yes �<No
❑ Yes �j(No
❑ Yes `QNo
❑ Yes �No
Reviewer/Inspector Name e
_ W
Reviewer/Inspector Signature: r . i (-+ t�'�. titer Date: I l C!
AL
3/23/99

Facility Number: —Z I Date of Inspection _ GtCI
Odor Issues~
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation? '
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
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 �Vo
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 Ko
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )'::�o
32. Do the flush tanks lack a submerged fill pipe or a permanent/ternporary cover? KY
Yes ❑ No
AdditionaLCornmentsanwr-Drawrn s
b0�1.1'l� t H A t z-1D
CD Cr io t3 1-7 ram.
I
O.S
t
C ri -r-<- tZS TAT
S!L t l 5
4©
W Ate-fl\C-
i
3/23/99

❑ Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
141 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection �q
Facility Number 7 Time of Inspection IDs 0 24 hr. (hh:mm)
© Registered P3 Certified © Applied for Permit 13 Permitted 113 Not O eratDate Last Operated:.,
.......................
Farm Name. .....�?tiv! c....... J►.St?k... ... vf1(� County:..............!��.�x�..........................................................
r
OwnerName: •.................... D.P.n.a' L......... .l f........................................ Phone No:...... .......................................
Facility Contact: .............................................................................. Title:............... Phone No:
........... ....... ........................................................
Mailing Address: ....... W......... T.��._.�rll!F.�............................................. ........ .ti�...t..l�!� ............................... ��h`7.....
Onsite Representative: .............. ........ pow .................................. Integrator:.....,... ..................
Certified Operator:............................................................................................................... Operator Certification Number:.......................
Location of Farm:
4�....hA .. .......5 .t'...� £ ...11 `�.., 1.. .t�e......ulns. - .o ...... .1.......................................................................................................... .&
....................... ......... _................................................... ...............................................................................
T
Latitude • 6 I�64Longitude 0• 0' 0"
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
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] No
b. If discharge is obsen ed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gaUmin? N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 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 99 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �!No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Mo
7/25/97

Facility Number: 3 -- L
r
8. Are there lagoons or storage ponds on site which need to be properly closed?
Ntructures_(Lagoons.Holding_Ponds Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard (ft): ....L
............:...........................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type :ISri!�.............. Gj�I T..te....................
.Y?.---.................................................
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.violatiens;or. deficiencies.were-nated,during this,visit..Yoil.'vd 1, rec've.no.ftid1ier,
. correspondence about this:visit: "
❑ Yes
No
❑ Yes
No
Structure 6
...................................
....................................
❑ Yes
[;S►No
❑ Yes
J9 No
'P Yes
❑ No
❑ Yes
�n No
❑ Yes
[P No
❑ Yes 0 No
❑ Yes ® No
❑ Yes 'M No
❑ Yes ® No
❑ Yes 69 No
❑ Yes RNo
Yes ❑ No
El Yes p No
❑ Yes P No
❑ Yes Wo
t7-- eros ioK filn-ns• or. i r1ru,`- �`1Ce rn] 1 Sh�lc�1`U e- t�i�ic� ccl� t, �!` �`tSAP ► ►rcc.ovT6 SkO4 � 1 � 01 . �11 I Lkt -{�cw vil om c'.e t_
� ff jj ��iiP � �p � �
�vkk 4-o CfriC.vlu4 YL�R At �� (Ck.�(r•Y►C�S.
*- k" sons OA-( ,)% `Au ?mns of �1r��i:� 4L_ ",, j i 4 S - wr,-s�r_
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: _J - / fDate:

`M 1 p
❑DSWC Animal Feedlot Operatioa Re�Iew
8,,` .,:� Spy a z'
' [� DWQ A,nlmal�Feedlot Operatlon Site;Inspeetlon
;Ar
Routine 0 Com faint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number I "]
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 3.S
PCertified ❑ Permitted or Inspection includes travel and processigA
❑ Not Operational Date Last Operated: `._.. ..... _..........
Farm Name: ._.^ ` 17 Y1t.\......... 1e.1�Q��4.r`._[ I(n1. .. _............. County: ;tom....... _.. .....
__..............
......_.
Land Owner Name:., .mot . `'!� %nit .... �1 ._._ ... __. Phone No:.��iL�.l$
Facility Conctact:..._�Q .__ i �a...........y ... __.. Title: ... ..... D-WALC._....... _...... ..-. Phone No:.�
Mailing Address: _...... .fie _._1c�1...�.........._........................I� . iC� ..... _........._..e
Onsite Representative:....l�lsr�_... rtl Pl7......_........ ....._. .... Integrator: _ jx.
Certified Operator: Operator Certification Number:
Location of Farm:
..... E... la ....
.................... _.. ...........__.........._ _.......... .....
Latitude ®• ®I �" Longitude
Type of Operation and Design Capacity
`-Design Giurrenf�`"., Des"rgn Cadent Desrgn Current
Swt e MIN,, h Ca acr�Po ulation� �Pouliryr � „ Ca "aci ` . Po Ulatron Cattle Ca acr GPo Matron
Wean to Feeder 2 ❑ La ❑ Dairy
❑ Feeder to Finish ` dO Non -Layer ❑ Non-
Farrow to Wean
Farrow to Feeder;F Totat De tgn Capacity D
_,�� _
Farrow to Finish SL"
❑ Other T
MOM -
Number ofagaons /HoldtngPonds Z ❑Subsurface ms DraPresent
❑ Lagoon Area❑Spray Field Area
r
-General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes ®No
❑ Yes ® No
❑ Yes [R No
❑ Yes (,� No
❑ Yes No
❑ Yes ® No
❑ Yes 0 No
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
Yes ❑ No
Continued on back

Facility Number:..] j......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
A No
Structures (Lagoons and/, r Holding. Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (ft): Structure 1 D Structure 2 _S Structure 3 Structure 4 Structure S
Structure 6
.LL .... ...... ... --- 4 A-..._---- _.........,...... .. W................ .. __....., .............
........ ........
._..... ..
10. Is seepage observed from any of the structures?
❑ Yes
CO No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
12 No
12. Do any of the structures need maintenance/improvement?
10 Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
U. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
J9 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type h?.....— ........ ..... _ .... ........._ ......... .. ......._..._........... _...._........ _...... ..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
IRNo
18. Does the receiving crop need improvement?
❑ Yes
[51 No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E[ No
24. Does record keeping need improvement?
Vd Yes
❑ No
Comments (refer to question#) Explain any YES answers and/or�any recomm endations or any other comments b
Use drawings'of facility to better explain situations ;(use addrhonal pages as necessary) h
5. Qc ms skodd be. bv'�,ell t+l c,,f o 1d r7ranlS (ocafJ , nru� A-4d � 4%.jj�Akr 4
12. eyty� n aft" orti bo`la�eons. skovld lot _`10 wiq\� C�j au��wiA� �&h► nseeM.
�nr� w�al�s aF �ag� sf �otJf d doe traWecl,
A k c 4Pace i 's. c� �ta�6r` 5��� be ati s� k. Ruark s�o�d aisa
HLi V\ 1 is k &_ r- anJ tmw,& cox4po ra oon ks% n O-'J m�,-�1�*�; r1 iS�sc►1
co l) 9 4 5
S�my ff(Od s 4r -Neor. shad] cow$ wd'i� Oan. .
8
cc. Division of water duality, water Quality Section, Facility Assessment Unit 4/30/97