310443_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai

Type of Visit: (3Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Q-Routine Q Complaint Q Foilow-up Q Referral ❑ Emergency Q Other Q Denied Access
Date of Visit:
S/ Ir V
Arrival Time: drJ
Departure Time: © County: Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Onsite Representative: Jp"G` ` /''tle�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Wean to Finish La er
an to Feeder Non
-L:
Feeder to Finish 11,49 W 0
Farrow to Wean
Farrow to Feeder D P.(
Farrow to Finish Layers
Gilts Non-L:
Boars Pul lets
'f urkev Poults
Phone:
Integrator:
Certification Number:
Certification Number:
Dischar es and Stream -Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cow
Cy alf
y He6ler
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yea
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes FN
❑ NA ❑ NE
❑Yes ❑NA []NE
[] Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: r3 - 'f D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
o
0 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
❑ N E
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
;
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ 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
❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZjeNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 U% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare 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?
Rcuufrcd 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? Ifyes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes E N ❑ NA ❑ NE
❑ Yes If �y ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes rNo"
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
(:)Yes NA ❑NE
[—]Yes rNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio3�11[:]
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 21412015 Continued

>Facilit Number: - pate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CJ-W--ff NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, check E] 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerllnspector 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
❑ Na
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes No ❑ NA ❑ NE
❑ Yes 0No [] NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
Mo
❑ NA ❑ NE
NA NE
'�' r#� C� Reviewer/inspector Name: V-OL"t r� � S Phone:
Reviewerllnspector Signature: Date: V6, it-1
Page 3 of 3 21412015 If

Type of Visit: 0 Co pliance Inspection V Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Youtine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: jf Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: 0 (>J,)p-t A j
Certified Operator:
Integrator:
Certification Number: 1216 77
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swinc Capacity' Pop. Wet Poultry Capacity' Pop.
Wean to Finish Layer
Design Gurrcnt
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
I INon-Layer I
airy Calf
Feeder to Finish
Design Current
Dr. P,ouItr Ei acit P,o
La ers
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turkeys
Other Turkey Puuets
Other Other
Beef Brood Cow
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? (I1'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? (I ryes, notify DWR)
2, Is there evidence of 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 Nn ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
[DNA ❑ NE
0 Yes ❑ ❑ NA ❑ NE
❑ Yes 6 ❑ NA ❑ NE
[] YesrNo❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
6
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2/No C] NA
[] NI:
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
ZNo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 3 threat, notify DWR
7, Do any of the structures need maintenance or improvement? ❑ YesZNo
[3 NA ❑ NE
8. Do any afthe structures lack adequate markers as required by the permit? [3 Yes❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L No ❑ NA ❑ N I:
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? Il'yes, check the appropriate box below, ' ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ E
N15.
Does the receiving crop and/or land application site need improvement`?
❑ Yes
r�4
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Yo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�] No
[] NA
❑ NEE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
76jo
❑ 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 ❑Checkiists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NEE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
2.4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes YNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fNo ❑ 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 [/NNo ❑ NA ❑ NE
❑ Yes E�/No ❑ NA ❑ N$
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
FJ'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5/No
❑ NA
❑ NE
Co nients (infer tn�ijuestiori #) .Explain my YES ans►yers;andJar any`addition�i reco"mmcndtitiuns;or:uny;other,.rornments;
Use drawi3rias of facility to;hetter exjilaiWsituatinnS (use; additiiurial`pagesasnecessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone.;
Date:
14/ 015

jType of Visit: Q0 7Routine
liance Inspection U Operation Review Q Structure Evaluation ❑ Technical Assistance
Reason for Visit: Q Complaint Q Follow-up Q Referral Q Emergency t) Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 4 r County:Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �Jd►JO.Toj(4) ��-�-�_�, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 39 1 i 179
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Pnuitry
Capacity
Pop.
Cattle Capacity Pnp.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Deslgn
Current
Dry Cow
Farrow to Feeder
Dr. I'oultr
Ca aci
Eo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
'Turkeys
Other
Turke Puults
Other
Qther
Discharges and Stream_ Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
(] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ ❑ NA ❑ NE
❑ Yes WNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Ins ection:9 (all
lyeste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5, Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta . threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ti10
❑ 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
ti o
❑ NA
❑ NE
maintenance or improvement?
Waste Antrlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
1v
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNy ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
N
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
VN ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes o ❑ 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 �K ❑ 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 21412014 Continued

Facility Number: - Liz Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2 N��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 WNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Uther 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 [:rNo ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes E24o ❑ NA ❑ NE
❑ Yes 2<1
❑ NA ❑ NE
[:]Yes ❑r NNo
❑ Yes [ N
❑ Yes hlc�
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Cornnimts:(refef to:question #): Explain any YES 6nswers,and/or. any additional reenmmendatiosm orany comments:
UseFdrawings of.,faelli to'het#er. ex lain si#tiationsluse additinral: a es as necessar }.
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phonkllk
Date:
6141YO15

U Division of Water Quality
Facility Number - D Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Co Hance Inspection Operation Review Q Structure Evaluation Technical Assistance
Reason for Visit: C,YRautine a Complaint D Follow-up 0 Referral Q Emergency a Other Q Denied Access
Date of Visit: Arrival Time: Departure Time:U County:,])�� Region:
Farm Name: T && y & W �_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
I--
Onsite Representative: a O AT �4_ _ e. � _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Ha er
Design Current
Dry Poultry Capacity Pop.
La ers
Nan -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? .
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
Dr y Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes C21 No ❑ NA ❑ Ni
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑Ni
❑ NA ❑ NE
❑ Yes VN,,
❑ [DNA ❑ NE
❑Yes❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
Page l of 2/4/20I1 Continued

Facilit Number: -PL4 T1 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? C] Yes /No
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No
Identifier
Spillway?:
Designed Freeboard (in);
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1, Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): __T71_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E6 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 ENo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ff'yes ❑ o ❑ NA ❑ NE
S. 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 12No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (Z/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?
E] Yes
❑
❑ NA
❑ NE
15. Does the receiving crap and/or land application site need improvement?
❑ Yes
fN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
6/N o
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Reauired 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
Ff 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 YNo ❑ 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 rN
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: I - IDate of Inspection: j
;4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 VNo
[DNA ❑ NE
27. Did the faciiity fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
❑ther 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 fallow -up visit by the same agency?
❑ Yes C?'No
❑ Yes Q No
❑ Yes 1a
[] NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
❑ Yes `io ❑ NA
❑ Yes E'-N/o ' ❑ NA
❑ Yes2;Noo ❑ NA
❑ NE
❑ NE
❑ NE
Comments.;(nfer tp questions#) Etplain any; YESwanswers and/or�any additional recmm�neiiidationsenrdny other'6m-ments:.
a.. r 1 . r., s.- • 4 x a. r.xs.
.:.
[lice drawings of facili . to, /letter, ea 'fain situations [use'additional ages as necessary} _. 43 x� �; _1 �.f a ;a . z�,5� �b• :,
�)W L)N�46�- A� O� /I
bila
Reviewerllnspector Name: jQN��,�. Phone:L?(P 3 V&
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/ m

I
Type of Visit: QCompliance Inspection Q Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up Q Referral Q Emergency Q Other D Denied Access
Date of Visit: Arrival Time: Departure Time: 130 -_ County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: , 0181U'AU M'11 Integrator;
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle RUMP,
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Fault .
Ca aci#
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I IOther
DischarEes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other: W
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [�] �No
NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: j -14 LC T-1 I Date of Inspection: nt sG
Waste Collection & Treatment `
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure l` Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA(��GN
2�No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard G 1
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El 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
n 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
hreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
*No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste. Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus - ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CWZ N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
N
❑ NA
[3 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
Iti1
❑ NA
❑ NE
Reaulred 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
ILJ 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 eNo ❑ 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes io ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: - Date of Inspection: el
24. Did the facilityfail to calibrate waste application equipment as re aired b the omit? Yes o NA NE
ppq Y P ❑ ❑ ❑
25. I§ the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes yNNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field
❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [Z/No ❑ NA ❑ NE
❑ Yes
❑ Yes
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
No
❑ NA
❑ NE
No
NA
NE
❑
❑
❑ NA
❑ NE
W[Ej<;
N❑NA
❑NE
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
FA ;,1_, Phone: Q d 954 -- 1m D
Date: 411-1,
214 OII

Division of Water Quality
Fpcility Number - Y U4 0 Division of Soil and Water Conservation
D Other Agency
rype,of visit: U 7Routine
pliance Inspection Operation Review p Structure Evaluation ❑ Technical Assistance
Reason for Visit: Q Complaint Q Follow-up D Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time:® Departure Time: t'L -� County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: slo"A-02 0����� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer Non -Layer
Pullets
Poults
Design Current
Discharges and Stream Impacts
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 Statc? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. W ere there any observabIc adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑Yes CZ No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes E(No ❑ NA ❑ NE
❑ Yes a,
o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number; -40 IDate_of inspection: q Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2<o ❑ NA ❑ NE
ti a. If yes, is waste level into the structural freeboard? Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J&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 UNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2No ❑ 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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, se#backs, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Yo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 5<9❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E14o
❑ NA
❑ NE
acres determination?
N
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 o
❑ NA
❑ NE
Re4uired 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 [ o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [Z(No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - ❑ate of Inspection:211
24. Did the facility fail to calibrate waste application equipment as required by the pemtit? ❑ Yes EI/Zo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
toe appropriate box(es) below.
❑ Failure to complete annual sludge survey [3 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
❑ Yesr
❑ NA [] NE
❑ Yes 10 ❑ NA ❑ NE
❑ Yes N❑ ❑ NA ❑ NE
❑ Yes
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
El"Noo [DNA ❑ NE
LJ No ❑ NA ❑ NE
is ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any. other comn>ents:;.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( 7 r
Date: A Z
21412011

' VDivision of Water Quality r
Facility Number D Division of Soil and Water Conservation J
Q Other Agency
type of Visit: 0 Compliance Inspection Operation Review Q Structure Evaluation ❑ Technical Assistance
teason for Visit: C Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: } I Departure'rime: Il_sga County: LW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: j o &J ATjAA'V Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Laver
Design Current
Dry Poultry Capacity Pop.
La ers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes ZNo ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
WNo
[DNA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - y 4 Date of Inspection- I*i a
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
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in)
[ `No ❑ NA ❑ NE
Q/No — ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
,,-A G_Zra�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Lj No ❑ NA ❑ NE
(i,e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 [:;rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EJ/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 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
pr�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5tri0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes [2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C 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 0 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of inspection: 4 q
24. Did tie facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E2/No [DNA ❑ 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 [:]Yes l,2 "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
eN❑
❑ 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
ZN9
❑ 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
0N❑
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations. or- any other.. comments::
Use drawings of facilit to better ex lain situations use additional ages as necessar
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:Q 1 b ^ f 7
Date: 'q 4
Z/4/1#ll

i vision of Water Quality
eility Number I L{� ? Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit (?%'[IIlance Inspection Q Operation Revlew Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint Q Follow up Q Referral Q Emergency Q Other ❑ denied Access
Date of Visit: a Arrival Time: Departure Time: County: 064_2e�. Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: n� Title:
Onsite Representative: Ja A'tWAO f r [ -ff1
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Owner Emall-
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = Longitude: ='U 0 ` =
11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
-- - ❑ Non -La er I I Eli
Other
❑ Other
�LL
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discha_ =& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 0
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)
Z. Is there evidence or 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 JNo ❑ NA ❑ NE
❑Yes
❑No El NA
ONE
❑ Yes
❑ No ❑ NA
❑ NE
5;] o ❑ NA
❑ NE
❑ Yes
El Yes
El NA
El NE
❑ Yes
ILi No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility ]dumber: " —Ltt j3 Date of Inspection
r
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 l Structure 2 Structure 3 Structure 4
Identifier: LA G1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
El Yes ❑No ❑NA ONE
Structure 5 Structure 6
❑ Yes 6"No ❑ NA ❑ NE
❑Yes LJNo Cl NA El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes ON ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ld No ❑ NA ❑ NE
❑ Ekeessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Sail
❑ 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
NN ❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;No ❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
o Cl NA
El NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
E ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LI t ❑ NA
0 NE
Comments;(rekr to question.#)::
Explain any-YES:answer''s�andlor' any: recommendattons:or any other `comments
t.... : ', . Via..... . 5 :..
`..•;.:
.,
:4 • i .a�'.:. '�i.:: x': :; s,'�? `•.i ;,' x:ti:r . q e .; iX :::•i�.i,: iy�."�.� .;,,�.. :..4 ��
additional a es as necessa _:: s
:Use. drawings;yt' facility;to better explain; situations: [use, p g
4S.:b.5,•::�.�• E!x -.. �i_c.... r: ; .`: x-u�=•: 1.. _ .
Name Reviewer/Ins ector
p
° " x '? g
a ; tifpflj �^ r ": Phone --
Reviewer/Inspector Signature:
Date:
Page 2 oj'3
12128104 Continued
i

Facility Number: Date of Inspection
RecMired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EK) ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
CJ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑.Yes94
[I NA
❑ NE
24, Did the facility fail to calihrate waste application equipment as required by the permit?
❑ Yes
IN
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
7No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) ccrtification? ❑ Yes ldNo ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2"'o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[J No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
N
'
El NA
El NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
33.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Does facility require a follow-up visit by same agency?
El Yes
N
El NA
❑ NE
[I Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
.r. 4t 3
Page 3 ref 3 12128104

Type of Visit 07Routine
Pliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0 Complaint Q Follow up n Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: �1 Arrival Time: Departure Time: County: D =AJ Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: � T tj A T AA m.TLLea-
Certified Operator -
Back -up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 a = g = Longitude: = o =, =
Design Current
Design Current
k�JfLDesign Currenppiy
I'apu atinn
WSet PoultryCapacitpacity
Pap�ulation
❑ Wean to Finish
JU Layer
❑ Daia Cow
❑ Wean to Feeder
❑ Non -Layer I
Daia Calf
® Feeder to Finish
j(POrb
L1 Dairy Heifer
❑ Farrow to Wean
pry Poultry
Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
ElElFarrow to Finish
El Beef Stocker
El Gilts
onts ers
Non-ersLayers
Beef Feeder
❑ Boars
❑ Pullets
10 Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
ZNo
1, Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
[3NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2No
❑ NA
❑ NF
other than from a discharge?
Page I of 3
12128104
Continued

i
Facility Number: 31 — 4t13 Date of Inspection q li a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. Il'yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: lA 6-yo-A }
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-7-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes E5No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Elth
Yes ILJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 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 dNo ❑ NA ❑ NE
maintenance/improvement? dNo
11. Is there evidence of incorrect application`? If yes, check the appropriate box below. ElYes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
,,,dNo
2 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
� o
ElNA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ YesWN
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑
❑ NA
❑ NE
Zr),) UFOAR WL e l' 1%- nl(l%/ 'Dwo try
Sows Ta-AS4 _o,) LACrad�-� 9-Ee-*-v PL S .
Reviewerlins ectar Name+f-1 :r s = �:3 •' ; Y '';. Phone: �6 3
p- z,, :E : 7 6 7
Reviewer/Inspector Signature: Date: 4 r p
rage I of s raaar9"C

Facility Number: 3 — y Date of Inspection G
Reaulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have 11 components of the CAWMP readily available? If yes, check
the appropriate box. have
❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 2 No ❑ NA ❑ NE
E(Yes []No ❑ NA ❑ NE
❑ Yes ZNo ❑ 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 E,(No ❑ NA ❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WN o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �IN
fa ❑ NA ❑ NE
26. Did the facility fail to have an active/ certified operator in charge? ❑ Yes o ❑ NA ❑ NE
Y p g
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
UNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Ld No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
AdditiongRGomments andlnr Drawings.:
_ -
T
I2a8104

ILI4
Type of Visit Co Hance inspection Q Operation Review ❑ Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: DL2PLZ4J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 ` 0 11 Longitude: = ° Q 1 0
Design Current Design Current
Swine Gapacity Population Wet Poultry Capacity Popu�lati�un
Cattle
Design Current
Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder -Layer
91 Feeder to Finish 41 6Z
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish La ers
❑ Non -La ers
❑ Gilts
❑ Boars Pullets
Turkeys
Other ❑ TurkeyPoults
❑ Other E10ther
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dal
❑Beef Stacker
El Beef Feeder
❑Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
/
1. Is any discharge observed from any part of the operation?
ElYes
D No
Cl 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 Statc7 (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[2 No
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElItJ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: ,j — Date of Inspection
F
.Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 14
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ZNo
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C 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?
Was_te_Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
El NA El NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
711,41/6- ❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
lw.rNo ❑ NA
❑ NE
Comments (refer to question #):
Explain any YES answers and/or any recommendations or any other comments.
necessary]:
Use drawings of facility to better expla l situat a additional pages asElm
Reviewer/Inspector Name'
- - d- - -- - Y '' .p,g.: Phone:774
Reviewer/Inspector Signature:171A_�_Lfzz
Date:
Page 2 of 3 / 12128104 1 Continued

Facility Number: — Date of Inspection
•Re ulred Records & Documents ,�,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No
❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Qfo ❑ NA [:IN E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain InspectioWeather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes
Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VN
❑ NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes LfJ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Id N ❑ NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues ,_�,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes N❑ ❑ 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 idN ❑ 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 N9 ❑ NA [:j NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Addltinnal Cnmme1i :s andlar 'Driiwln ` s 7� ' x... s:.
7
Page 3 of 3 12/2"4

V division of Water Quality
Facility Number Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit Cif 71Routine
mpliance Inspection Q Operation Review a Structure Evaluation Q Technical Assistance
Reason for Visit Q Complaint Q Follow up 0 Referral Q Emergency p Other ❑ denied Access
Date of Visit: k Arrival Time: ; 3 Departure Time: County: DUP L.t-jJ_ _ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �' ^`NATHArJ _ ��1 ���tfL_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
n°
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
1 Longitude: = c = 4
Design Current Design Current
Swine Capacity Population Wct Poultry Capacity Population Cattle
❑ La er
❑ Nan -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish IlLop kq 5 o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
Beef Brood Co
Number of Structures:Eli
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 lr l No ❑ NA ❑ NE
El Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
l,�!J,/No
❑ NA
ElNE
❑ Yes
L7 No
❑ NA
❑ NE
12128.104 Continued

Faci!it Number: 31 Date of Inspection
IVaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ENo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Stricture 3 Structure 4
Structure 5
Structure 6
Identifier. CA bcesaJ
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 strictures on -site which are not properly addressed and/or managed
�,/
ElL1 Yes No
[I 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 environmentaZo
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
El NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? E] Yes ❑ NA ❑ N
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes IIJ No El NA El N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ N
maintenance/improvement? 11, Is thcre evidence of incorrect application? If yes, check the appropriate box below. ElE Yes N❑ ❑ NA ❑ N
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I01A, or 10 lbs ❑ Total Phosphorus ❑ Faiiure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DriR ❑ Application Outside of Area
E
E
E
E
E
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
VNo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Nz o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
ElNE
18, Is there a lack of properly operating waste application equipment?
ElYes
LJ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a -cc.. kL«aaF Ar --Aar". SFr,❑ Coc f
Reviewer/inspector Name IJO 4W rAaPJ. Phone: 9/ — 1,56
Reviewer/Inspector Signature:,,,,, Date: —
r 16/zwuq 1-Uniinue"

t
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Ocher
❑ Yes L./No ❑ NA ❑ NE
❑ Yes l.2 No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,1
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
6 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
�❑
0Yes
❑ No
Cl NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,_�No
El o
❑ 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
[Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector rail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit PCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: 15 Arrival Time: Departure Time: County: Raglan:
Farm Name: % "�C_rf �� I ��t]T-LGr r��� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6e'r[p
Certified Operator:
Buck -up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certifieation Number:
Location of Farm: Latitude: 0O [= ' = u Longitude: ❑ a 0 6 = ii
llesign Current
Design Current
Design Eurrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
I
I I
I[] Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
I
I
IEI-Non-Layer
I
I
❑ Dairy Calf'
Feeder to Finish
❑ Dairy Heiler
El Farrow to Wean
pry poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
Layers
❑ Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
Pullets
❑ Beef Brood Co
Turkeys
Other
❑ TurkeX Poults
❑ Other
❑ Other I
Number of Structures:
Discharees & Stream lmnacts
1, is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
❑ No
❑ 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'?
Page 1 of 3
12128104
Continued

Facility`Number: 31 — yy 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste: management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ 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
14. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 Q% 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 I I
12. Crop type(s) S (-, 0 -Q r�a.� CIZ ) , Joy L., 3, 1 h�{,� k
13. Soil type(s)
14. Do the receiving craps differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
..Comments (refer to question #): Explain any YES answers and/or any recommendations or any other.comments....:
Use drawings of facility to better explain situations. (use additional pages as necessary):
w e �rx,�co eu �� cts w ea
F Pef(Y-\�1
Reviewer/Inspector Name l;] ~ �. Phone: — `9 2�y
ReviewerAnspector Signature: Date: [} 6
Page 2 of-3 LIAMIU4 C'antinuea

' Facility Number: "�51— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ W[.IP El Checklists ❑Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ❑ No ❑ NA ❑ NE
Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
CELainfa)ll ❑ 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 ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes El No El NA ❑NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes El No ❑NA ❑NE
Additional Comments and/or Drawings:
^ 1
lad D6 jr�
' F 0
�-�
- �� e- cc's Q rt
(—rx� itch
s-4p (' C C-0 �-0 `
V�}�
SL'�
Page 3 of 3 12128104

Type of Visit 0 7Routine
Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ❑ Complaint O Follow up O Referral O Emergency ❑ Other ❑ Denied Access
Date of Visit:
2 Z a
Arrival Time:
Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name:
'Nailing Address:
Physical Address:
Facility Contact: yl' Title:
Onsite Representative: GNO _ LC0+0_
Certified Operator: f 40f uoYj F
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
lJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = « Longitude: = ° = 6 =
14
Design Current Design Current
Capacity Population 'Vet Poultry Capacity Population
❑ Layer
j10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impact
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
i
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ BeefStockcr
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: El'
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 ENo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NF
❑ Yes [,� o ❑ NA ❑ NE
❑ Yes l:.,f No ❑ NA ❑ NE
12128104 Continued

Facility Number: — qDate of Inspection Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storin storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Struct re 1 Structure 2 Structure 3 Structure 4
Identifier: LA= I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed?
00 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 E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes C(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify OWQ
7. Do any of the structures need maintenance or improvement? ElL'J Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste ARRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes iNo ❑ 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) M (3C tJ f,1
13. Soil type(s) MAjt v ��
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment?
19'j CA-_&P CC A00
t,) ILAyj raLk• +
pert-m3Z
❑ Yes
[] No ❑ NA ❑ NE
dNo ❑ NA ❑ NE
E , o ElNA ❑ NE
o ❑ NA ❑ NE
L"JNo El NA ❑NE
Reviewer/Inspector Name 5r ty °� "` r' L Phone.(. It �
Reviewer/Inspector Signature: Date:
12128104 Continued

.T+acility Number: 31— Date of Inspection L ��
Required Records & Documents
19. Did the facility frail to have Ci rtificate of Coverage & Permit readily available'? E Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? [ryes ZN4
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes o ❑ ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes ❑ No LJ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N
❑'NA ❑ NE
}
2ti. Did the facility fail to have an actively certified operator in charger
❑Yes
rNa
❑ A ❑ NI?
27. Did the facility rail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
L.ii NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance: of the permit or CAWMP?
[:]Yes
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
7No
❑ 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
LZ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L/J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit A Compliance Inspection C) Operation Review Q Lagoon Evaluation
Reason for Visit QL Routine Q Complaint 0 Follow up D Emergency Notification Q Other ❑ Denied Access
Date orvisit: � Time: ' .sue
Faeiiitr• Number
10 Not Onerational 0 Below Threshold
Permitted ZCertifled 0 Conditionally Certified [3 Registered Date Last Operated or Ab ve Threshold:
Farm Name: o xt : ��� County: � `aq
Owner Name:
Mailing Address:
Facility Contact: Title:
OnsiteYRepresentative- U"G!1! At 4 n ed/�J
Certified Operator: �� 1/ w't
Location of Farm:
Phone No:
Phone No:
Integrator: \1xer........
G.�4
Operator Certification Number:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 6 " Longitude ' 6 0 •
Design . Current
Swine ranneity Pnnulation
❑ 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 Capacitv Population
❑ Layer ❑ Dairy
❑ Non -La cr ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
.:.
"Nuriii;er;af:Dagaons Subsurface Drains Present
Hiilding P6nd91 Solid:Trapv,: No Liquid Waste Managen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated now in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection $t Ircatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05IV3101
Spray Field Area
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure G
Continued

Facility Number: N — M Date of Inspection gzm
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
t seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
I2. Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility• is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reaulred
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WllP, checklists, design, maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie.' discharge. freeboard problems. over application)
❑ Yes
❑ No
D.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24•
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about thus visit.
;I — Sri+. yx-•ti .•tC::::P' c&: r xc_;.•..xr- .,...rx^^wsa.r �a +srha7a.-aw: a
iiRmetits r f it t uestioii E an 'Yi+S aest+reta and/or, recainmendatiaua.or " x ` Ca e e t+ ii other• comiiiii ' ' „
Us.e.ndrawings ofI ty tor sit� naa.t.iof+;sf:.�(use
s *nanal Pages as aecessj=
Iemtsmar
Field ConFinal NotesIa`
YexpIai"n
']�brtat'wesa�.vddi��..'�.za...aw_*F«'r.•yy�� ,
.—. i�:.. •;.:CC}�'fL. !1t4. %did%: 'ri4�.�"r.Ji.... �A..Y�il'.a ..1 e..y 1+�^+-Tww.•.w�.. ��� w :.E.i��i . �S�IVr'Cw.�•
Reviewer/Inspector Name` ?' tµ ��r,� ' ;�'-. w-�r :;'�"x�rk'a .
Reviewer/Inspector Signature: Date:
05/43/0? Condnued

Facility Number: 31 — Date of Inspection
or issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28, Is there am• evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
M Were anv major maintenance problems with the ventilation fanf s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑Yes El No
❑ Ycs ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

Type of Visit Compliance Inspection l] Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine ❑ Complaint Follow up ❑ Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 Date of Visit: ± L Time: E Z
t ❑ eratf low Threshold
U Permitted O Certifled 0 Conditionally Certified © Registered Hate Last Operated or Above Threshold-
Farm Name: L".-) a Vn _ r Poi '-V-% Counh°: 'D "� 1; �'"► -
Owner Name: D d n ej Id L.o4'''•' 1 Phone No:
Mailing Address:
Facility Contact: 1 Title:
Onshe Representative: 020 -n cl {d._.
Certified Operator:
Location of Farm:
Phone No:
Integrator:y n .j i ,-. q•r J ►�-. J- _
Operator Certification Number:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 " Longitude 0 1
an ine
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feede
❑ Farrow to Finist
❑ Gilts
Resign
Ca acfty Po ulation:.=Pi
IF
Design.. Current :Design: ::Cur
Ifn
'Capacity Pouulntinn ...::Caine Ca>7acltii
Number.of I:stgeans .,:.; . Subsurface Drains Present ❑ Lagoon Area S raw Field Area :
Holding Ponds I Soll I Traps... k
❑ No LI uld Waste 1Nana ernent S stem is
csl�harges _4 Stream tmRagts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier; !
Freeboard (inches); V 7
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: .3 ) — 4
IIII O-L
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions " 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?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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 ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Oyes
❑ No
c) This facility is pended for a wettable acne determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
'Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reguirgd
Records & DacuMents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel Wi1P, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
„a�es
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes O'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Oyes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question ft). Explain any YES a»w and/or, any recDnnmendatians or any-othercomments ; . a ;il.. iir u
Use drawings of facility tD better explain ttiatioins. (use additional pages as necessary)., n
Field Copv ❑Final Noer
`�at'1 ; 3 1 "►S�eG^f i 6 �''+ w Ii S GO+^1O� V G-� C'Ll� � 3 a ,�a��L3G..► V� .
Z . �jt7iw►aj Swine Lv�sJ�t ptl9p�otir^S -!e sae
41 t? $�4 ►^at 1 ,� 1 /t • 'Pj G4v r e s A'�1 Sq --k e ] is L­' c
ecAJ A we -}able Aerev 4e,4 41'aI-,
rtt-�[ -� c•v G ��e 1 �-.. T� �' e } Z tr ele r e-1
r�+1G0tei ati sl-teOs- MPe-Of 46 be ✓aI ble 4 Loula',-uvCA)
r
Reviewer/Inspector Name.�oMh wl l) w �+r" ►.. 1.".. " ..
Reviewer/Inspector Signature: Date: 5 )1 6L
05103101 90 Continued

Facility Number: 31 -- Date of InspectionjJY�
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28, is therc any evidence of wind drift during land application? (i.c. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. 1s the land application spray system intake not located near (lie liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation Jan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals fecd storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
.Additional Comments and/or Drawings:. .
�r�.�.pvl,�►�tvel[� ��e LvgN)-Fe fletn r' YYL,C,re� zrPN
15
AL
or e L,,e,11W bI e ctz M 1-Qv r) eel s
40 rv,� �F Ajorv]� ca�,'❑n s ofrr7 q cL�fdarl�� w.'�� -�1,e
k/e ct dtc ,-e e4c,,-*,1 ,714t'v n i 1-va,54e 11c( n-
lq . M v,. Loom,'-( se,ys gk-a -� he sf-,-a yed wcg-q e
41nr PA 5 -} 3 w ec 1c s . Pe. sa )' d h e '5 orn C1 ye4 onda
f 1, k Pe; d Cop, se C v�-�'v�e Ate W
� o�c..� a ,'-1 � �.v o u/ ew/c s - h 0 4-'%
rla . M-y o►►-,; s does na- hAlve 4ese-
dec vw.e4}eA .
rtrrebegr,a ►,',eeov-ds h.,,tee net 4ee►i ►^ecofded s1'vvre
A w4s4c g^4q1 �� s �S ►7tede'o( 1,,- 44e w as � peen+
ItrUu I el`4 i 0 vN S 41,G1 kvI V . LOD+^? s S -51 y S & a y-t' id C .
C f
7 �r'. LQo�'�'1i'S L f N)OOh e I,,IVe-d ]eve] ►"s
�elow 4ke level i4 .sl10,'L ept -TP1 e4L-,e.,wards)
-Ale, 1 G Y '6 a s b ee Y) r v +^-�Pe o� �e le r ,v Ao 4,y p v,,l f /C Ve ] .
15. ,-av►ie a��as Q�' 44e -�';e 1r.� heed -�e hr -1We nay berw\LJWA
v e a1 e—4-Gl4 i el'1 e� 1 i ►-� i ►t� �C� '^+ Ol �� r +�►'4 t/pi r✓1 S1 t.t D� �7 �jL. � r�
es4r,bh,sked,
Z 7 , eaej 1-\a9 s ;�, m �
er �'�' QF 4)ie
jh,a12
rt:e
1M V-• r; ea,^'►� S 5A4 f he'aS r1^we bee"1 41neeZ' r+-,GY?4I -e
-� Nd h e Sa s ke 4o ,,- a4 i6 eever 4 4e--i v . �4 q )s o
g
el r ,' S -� k c+ vn d r e 1, o s k a v e b ee►-t dd r� eDl j'I c r'c
1}1 �kc A.s a3-.Of kaVe M1)T b V 6 h Geve%,-e
05103101 / Z, 4� r � VC it "''� C 1 55 w f, � S
-r,' ---� f a 1 += 1 * 4s

w'r1
.�'-1
["-,
...... .. ..t. .. t.. .... ... ........ ..:.. ...:...
::. -
isia t=al
ii3
^'sari
p Sv tt d�.Water:Ctib aR.:•p.�.,..k.
,
:
.i,r 'i '.i.
, .
-❑:f71►�isia
,»;,f: �% •.t.3
h r�' Agee ^sS. i. ��1.:: ':I:i
=,,��uf€=�': �,�:::
:..s:'.�;�'� .Ik•:t �S'4u. 3: �i�i:=:. .:2.::; �:�:.1 ';
•.�:?.::.i:.
;��:. ..fir
.. ....5. .. .. .. ..... ._
,L .
� . .I.. .. .s.- . ...� s ..« _ .. .... ....: .:...... ,.. t .. ., ... .. r....
.3�:r..:=
�. t ............t..... w. ... .. �i: is t... .... _....f•s€' . �.'�: .. .. .� ��;;'t!;.3......�
Type of Visit 91compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint O Follow up ❑ Emergency Notification Q Other ❑ Denied Access
Facility Number 3 3 Date Of Visit: 2 Time:
Y t ti elo►v T esh
© Permitted © Certified D Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: County: -
Owner Name: d'"ti� L��'' �� $ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: D o""t et 1.4 C110b." �Z~ Ajhjri y u "� ►Tn g _
r integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0• K Longitude e 1 0
Design Current Design Current:. Design ' ,, . Current
Swine _ Ca achy Po elation Poultry Ca aci ....: Po ulation ..Cattle:::: Ca 'aclty .' Pa dkation: r
Wean to Feeder Layer ' Dairy
❑ Feeder to Finish ❑ Non -La er Nan-Dai a
Farrow to Wean
Farrow to Feeder
❑ Other E.
❑
Farrow to Finish ry Tatal Uesign Capacity
❑ Gilts
❑ Boars Tot �1:SSLW
Number of Lagoons Subsurface Drains Present La ooe Area Spray Field Area
-...y,,.... 1
Holding Panda 1 Solid Traps No Li vid Waste Mana ement S stem
n'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, Is storage capacity (freeboard plus stonn storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inchcs):
05IV3101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

� Lit
Facility Number: J 1 — 4 3 Date of Inspection i z-
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures vn-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12, Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JONo
24,
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer10 question # 'Ex lain anyY>ES answers audloir an 06ii6inentlstions or any other col iiments:' , p ' '` F Y
Llse drawings of facility to.bettcr expW a situations. (use additional pages as'neeessary)t' �❑ Field Conv ❑Final Not"_ • ;�} 7.
yTwe w gs4e in ke lie 1 e t a[ S pur,%reef vi-ko Ve e-��-� o►•,
A,d e,c0nt 4.0 +ke llo/e q-xd i \ -j-1 e edge 0-jr 44e s-may
A / S 0 4',e 6Ar '4 e"Ivf J�Qn s I'" qke he le Were J L1'-;ed ' `rl ese
Reviewerlinspector Name �� h eW A i ij p$►/ CJd 1[s d'h.�
Reviewer/Inspector Signature: tiAl Date: 12
05/03/01 q Continued
bra �� 1 T,' �► e Y 2h.- � S �►,; �,
SMA Ii'�Inn

bl�
Type of Visit V Compliance Inspection Q Operation Review Q Lagoon Evaluation I
Reason far Visit (.Routine Q Complaint Q Follow up ❑ Emergency Notification Q Other ❑ Denied Access IJ
Date of Visit: fi Z Time: l
Facility Number
Not operational 0 B clow Th res hold
O Permitted W Certified O Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: County: ",H _
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _ 6'r—ao� ilAC�iis�
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: _�r � e"Oe"? `
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 066 Longitude 0' & 066
Design Current Design Current Design Current:
Swine Ca acit Po ulation PoultryCapacity Population Cattle Ca aci . u uiation
Wean to Feeder ❑ La cr ❑ Dai
Fccdcr to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SAW
Number"'of Lagoons t* ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area E
M.. H6Iding.P6niis'1 Suiid Traps No Liquid Waste Management System
Discharees & Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2, is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Cl Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _
Freeboard (inches):
05103101
❑ Yes M No
❑ Yes El No
❑ Yes ❑ No
❑Yes ❑No
❑ Yes &No
❑ Yes 91 No
❑ Yes PS No
Structure 6
Continued

Facillty Number: f --L� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvemcut?
B. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste -Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type C4"X1
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?
Rcaufred Records & UaFpgZFnts
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes allo
❑ Yes ® No
❑ Yes R No
❑ Yes [RNo
❑ Yes 0 No
❑ Yes C9 No
❑ Yes ® No
❑ Yes kNo
❑ Yes ®No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes K No
❑ Yes [R No
❑ Yes El No
❑ Yes [4[No
❑ Yes [KNo
❑ Yes [N No
❑ Yes KNO
❑ Yes
❑ Yes
❑ Yes
❑ Yes
[Q No
®,No
KINo
M No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.. .• :: ..; .,.. ...:::':Y.': moo::: •.µii:iS:
omments.(refe. �:d/or:�:an•.. y:'. .. �•,'i::.;:".'::M;,�ya��lEL"Ai:aSSi Ctis=G.�d,...�i; .':. ..'.b.'S:c.'...: ..,L�:Z�•s� .
Cr.tu yueExplain a stlan #): ny. YE$ aniwersYan.. recommendations,o�any;other;comments..,
Ll c tlr imugs of facility to better explain sitiiatiarts`{tise.addit[ nil pages as riecensary) � ❑ Field Copv ❑Final Notes t'
gw •.§I p .. M .k"3Se•`'Y.
�I7� • � � ► +�T f 1()de® 74P LDu'6V_ Ai � Zetldl ilt -lXG Z.Lf6 o drt -/D
pel. F [�rlt+&41 jrrn. [ Sv0A Zfv6,l j/®v lee 1G •k
4,
Imo'
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
051193101 V Continued

Facility Number: ' / — Date of Inspection
Odor Issues
26. does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes MNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes r.No
28. Is there any evidence of wind drift during land application? (i.c. residue on neighboring vegetation, asphalt, ❑ Yes tNo
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 ESNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) [3 Yes kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 6 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [] No
lljLfLljtlllll

Type of Visit (& Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Vlalt O Routine Q Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Date (of Visit.. ® Time:
Facility Number
Operational w Threshold
U Permitted 0 Certlf��i��ed 13Conditionally Certified []Registered Date Last Operated orrA�Above Threshold:
Farm Name: Ad6IWn County: __ _ __ /r./u�1 on,
Owner Name:
Mailing Address:
Phone Igo:
Facility Contact: /J ,/�/ Title: Phone No:
Onsite Representative: .__[ %7tf 1 ��7f1�f Integrator: _ _t%'C _. tr.+te►��
Certified Operator:
Location of Farm:
Operator Certification Number,
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude r_ le 1 r-�u Longitude 0' 0� 046
Design
Swine Ga aci
❑ Wean to Feeder
Current
Ptr ulativn P.aultr
Layer
,Design Current °
Ca anci Po u a ion Cattle
Dai
Resign Current
Ea aci Po ulatlon
Feeder to Finish
on -Layer
❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
Other
,:.. Total'Deslgn Capacity
Total SSI1W
� •.
❑ Farrow to Finish
Gilts
Soars
Numher of Lagoons �■
!•iolding Ponds 1 Solid Traps
Subsurface Drains Prcscn:tjj0 Lagoon Area IM Spray Field Arca
No Liquid Waste Management S stem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water ofthe Stale? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) Cl Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes FNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Trgalmign
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes QNo
Structurp I Structure 2 Structure 3 Structure 4 Structure 5 Structure d
Identifier: fPGI ry�
Freeboard (inches): 3-7
05103101 Continued

Facility Number: — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
Immedlate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 0 No
❑ Yes F] No
® Yes ❑ No
❑ Yes W No
❑ Yes 0 No
Waste Apylication
10. Are there any buffers that need maintenance/improvement? ❑ Yes M No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes K,No
12. Crop type �(r 7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M No
14, a) Does the facility lack adequate acreage For land application? ❑ Yes U No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15, Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Reguired_Records & Documrcots
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RNo
18. Does the facility fail to have all components of the Ccrtil-ied Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
(�kNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N.No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
allo
21. Did the Facility fail to have a actively certified operator in charge?
❑ Yes
$LNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�R.No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Q No
24. Does facility require a follow-up visit by same agency?
❑ Yes
P.No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.. ••,/":.:a.. A" r!P'.=.!idC:',.iba'<-;, q.��:b.'�•.;'�,':' ��`���..,':: .',';,�::
question #j:"'Exj lain'any,:YES„answers and/or any recommendatians,or any other cammentsr'';;=^ :
SCornmentaftefer,to .
c^.5-ii^ ::..5<-•Y ;:..='.. xw �.,n: :.:• :. .. .:.�.�...�:.,,:�.. .: =w41
'Use'drawln s offacili to•better:ex lainsituatians:• use additional pages as necessar
t g..;.... tY p p 8. Yl
,,:,, •,.,-, '�:�:� Field Copy Final Notes
�{�._,���:;g •,,.,
:j:: e : /.g:x"s�..f.:•.. p[.=i. .i.':' �'4':^'t'• �iT'.:i:':::;��,
7 -14d lvm 6 v Q we coo&c &L ► R h e,- d- d v f `fir r! /d4Pt Goa zv f T
oh ZO, ih Sl c did o fP'D®
ReviewerfIns ector Name C
P 4ad ,ems. �.��.::', �:,•;:<�.:�..... .
Reviewer/Inspector Signature: Date:
0510310I f U
Continued

Facility Number: — date of Inspection D�
Odor Jim
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 F.No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )E�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 IS No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes Z No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes FK1 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ®No
Additional Comments andlor:.Drawiq a:
05103101

Diilsiot'pF.Water C�uality �•: .:r;
Division of Soil and 'Water. Conse6ation r.•r ,,*
0 'A er g eric r. y .:
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 6Routine D Complaint Q Follow up Cf Emergency !Notification Q Other ❑ Denied Access
Facility Number !late of Visit: t L]=1�Tirne: L t' S � Printed ail: 7/21/2000
l 0 Not O erational a Below Threshold
Permitted 13 Certified [3 Conditionally Certified [3Registered hate Last Operated or Above Threshold
Farm Name: .......1 ]]'AhQ.....Q� .... .!..................................................... County:...;...i......................................... .....................
..
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ........................................................................................ . ...........................
Onsite Representative: .• �?'�'-:.`---sir................... Integrator:...�y'! ..............................
Certified Operator:
Location'of Farm:
Operator Certification Number.
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude 0 6 « Longitude • 4 44
Design Current
s ""' -A. ki Catiaelty .. Population
.; Wean to Feederee
x: Feeder to Finish
C.Cl
3C:i=
.r�:. Farrow to Wean
:,: Farrow to Feeder
it's: Farrow to Finish
c'sr
Gilts
Boars
Design Current Design Current
Poultry Capacity Po uladon Cattle . Capaiielty.. Population
❑ Layer I J[] Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total Skw
a�''•�NnmxJaagpuns ���'''� Subsurface Drains Present Lag -,,Area OSpryFild Area
Hoid#ug Poitid§ I, Solid 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flaw in gallmin?
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 s(orage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Idcntifie r:...................................................................................................................................................................................
Freeboard (inches):?
5100
❑ Yes kNo'
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes D�No
❑ Yes XNo
❑ Yes Dd No
Structure 6
Continued on back

4
Facility Number: 3 — Datc of inspection
Printed on: 712112000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Mrf to
(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/improvemew?
❑ Yes
'Mo
WT
S. Does any part of the waste management system other than waste structures require main tenance/improvement?
❑ Yes
qNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
g No
Waste Application
ID. Are there any buffers that need maintenance/improvement?
❑ Yes
RNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
Pq'No
12. Crop type]
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
f<Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
MNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
b(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
gNo
Required records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
ONo
(ic/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VjrNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
jqNo
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
(ic/ discharge, freeboard problems, over application)
,ZNo
23. Did Reviewerflnspector fail to discuss review/inspection with on -site representative'?
❑ Yes
birNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
9No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ZNo
r!1Q•YIions D ' Fi*C futtho ,
CflI'I'i!5 Dllf�£t lCt'. ii ]UUt t�115 V 1511'. . . . . . . . . . . . . . . . . . . . . . . . . .
- fer 1—
m nments:(retq,questiot #):= Explalri'any;YES ansi� ei^s i3ndlor aay;ireeuIilrllCiil[Ii3tiQiL4 QI aA1 + otlwer co'sxunen
- .,
ie drawir� of facfliiy;tv'lxetter ex lain sittiatioa: (use additional.""u es 'riecessiirry}:: x e =� ' ;, ; 4':;
e
1 J� cox—,
—,
P PV\19A14)
:
AL
Reviewer/Inspector Name
Reviewer/Inspector Signature; Date: { 1—. ��--0� . _ 5/00

Facility Number; Date of Inspection
Odor Issuer
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below WYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27• Arc there any dead animals not disposed of properly within 24 hours? ❑ Yes *0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken Can bladc(s), inoperable shutters, etc.) ❑ Yes ,kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 4 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes IANO
Additional Comments an or Drawings: rr: .�.i i, S
�•i �'��P �['�
-�' � e � e�4� `t 4. ��e►- Cam',--�`>,�-t � �
0

4Division of Water Quality
Division of Soil and Water Conservation
O Other Agency
(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number hale cd visit: Prinled on: 7/21/2000
8 Not Operational Q Below Threshold
Permitted ❑ Certified © Conditionally Certified Q Registered Date Last Operated or Above Threshold.
Farm Name: ...... Cl....''... ................................................................... Couiitv:..............................................................................
V) `�
OwnerName:........................................................................................................................... Phone No:.......................................................................................
FacilityContact: ..............................................................................'I'itie:................................................................ Phone No:...................................................
FlailingAddress: ............................................. ............................................................................. .. ...............................
Onsite Representative: t-"' 1. Intcgr:itnr:.....]R ............................
Certified Operator : .......... ......................................... .................... ........................ ........... ...... Operator Certification Number:..........................................
Location (if Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse • Latitude ' 4 •6 Longitude • �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ID Layer ❑ Dairy
Feeder to Finish 10 Non -Layer ICI Non -Dairy
❑ arrow to Wean
❑ Farrow to Feeder ❑ �thcr
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag++.�n Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste ,Management System
Discharges & Stream Im acts
1. is any discharge observed from any part of the operation? ❑ Yes K No
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observcd, was the conveyance man-made? ❑ Yes [--]No
h. If discharge is observed, did it reach Water of the State:' (II'yes, notify DWQ) ❑Yes ❑ No
c. If discharge is obscrved, what is the estimated flow in gallmin?
d, Does discharge bypass a lagoon system? (Il'yes, notify DWQ) ❑ Yes ❑ No
2, is there evidence of past discharge from any part of the operation? ❑ Yes j (No
3. Were (here any adverse impacts or potential adverse impacts to the Waters of the State other than rrom a discharge? ❑ Yes WNo
s
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes eNo
Structure I Structure 2 Structure 3 Structure 4 Structurc 5 Structure 6
Identifier:..............................................................................................................................................._........... ....... ............... ..................... ...............
Freeboard (inches): �-3
5100 Continued on back

>facility Number: 31 — Date of Inspection Printed ern: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'! (icl trees, severe erosion, ❑ Yes b�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes N No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovetnent?
❑ Yes
MNo
8. Does any part of the waste management system other than waste structures require tnaintenance/improvement?
Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�(No
Waste Application
10. Are there any buffers that need inaintenancelimprovemen('!
❑ Yes
N�No
11. Is there evidence (if over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
t5No
12. Crop type t t sq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONo
14. a) Does the facility lack adequate acreage for land application'!
❑ Yes
t�No
h) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended fora wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
jRrNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
&No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
K N❑
19.
Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
❑ Yes
NIo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[R:No
21,
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
gNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
XNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
�zNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
25.
Were any additional problems noted which cause: noncompliance of the Certified AWMP?
❑ Yes
N[No
;or doflcie;r�cie -►here n4gp0. il(t-r;ing t;hls'vjslt' • Y:ou will reeeiye nfl fuethoe . ...
corres pride-&ab"fthis 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): l r
SZ-V4k
Reviewerllnspector Name
SIUOReviewerllnspector Signature: a

Facility Number: — Date of Inspection GQ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building it) the storage pond or lagoon fail to discharge At/or hplow t2ryes ❑ 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 4No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [ kNo
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 kNa
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals Feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes J�No
AMMonal CornmentS an orDrawings:
5/00
5/00

13 Division of Soil and' Water Conservation -Operation Review
,3 0 Division of Soil and Water Conservation l- Ctimpliance Inspectioin,4
Division of Water Quality- Cprtspliaice Inspection ' �►
ther Agency - Operahon'Revisw
10 Routine O Complaint Q Follow-uE of DWQ inspection n Follow-up of DSWC review Q Other
Facility Number Date of Inspection
1'lme of Inspection ffiH 24 hr. (hh:mm)
91 Permitted 9(Certified © Conditionally Certified © Registered 113 Not Operational Date Last Operated .
Farm Name: ......................�bW. ............... I_-................................... County:............ C.0 F�......................
....
...................
l
Owner Name:......G .. ,... ... .............. Phone No: �f1�. �... �l� ..............
Facility Contact: ........ .....I..-�. 'E!I/'�� ............ Title: .... ................................................... Phone No: ���®��
g .Address: �p
�.......... or..........1�...1. ....�.....................�n,..........--
Mailing ..................
Onsite Representative: ,alerWW .-.........kzemf....................................... Intel;rator:......................................................................................
Certified Operator:..... ........... ............................... Operator Certification Number:-..................................
Locution of Farm:
.............................. ..................--....
Latitude Longitude �• �� ���
Design Current ;.' Design Current Design Current
Swine, Capacity Population _,Poultry Capacity. Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 1E] Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish I Tntal Design Capacity
❑ Gilts z.
❑ Boars Total SS11W
4Number of Lagoons JEI Subsurface Drains Present ❑ Lagoon Area 10SPray Meld Area
Holding Ponds 1 Solid Traps E== J❑ No Liquid Waste Management System n
Dischar— & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes � No
h. If discharge is observed, did it reach Water of the State'? (I1'yes, notify DWQ) ❑ Yes No -
c. if discharge is observed, what is the estimated flow in gallenin?
d. Does discharge bypass a lagoon system? (If'yes, notify DWQ) ❑ Yest No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes I�No
Waste Collection & Treatment
4• Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes *No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure f
Identifier:
Freeboard(inches): ........; ....................... ............................ ...-....-.................................
5. Are there any immediate t rcats to the integrity of any of the structures observed? (icl trees, severe erosion, ❑Yes o
seepage, ctc.)
3/23/99 Continued on back

Facility Nymber: --y Date of Inspectirrn
5. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maxitnum and minimum liquid level
elevation markings'?
Waste ?%yplicution
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes o
❑ Yes (KNo
❑ Yes P❑
❑ Yes iNo
❑ Yes 5eNv
❑ Yes 9No
13. Do the receiving crops differ with those designated in the Certified Anitnal Waste Management Plan (CAWMP)? ❑ Yes VNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the Facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes Z No
15. Does the receiving crop need improvement? 9 Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes KNo
Reuuired Records & Documents
17.
Fail to have Certificate of Cgverage & General Permit readily available?
❑ Yes
�No
I8.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, ate.)
❑ Yes
"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
No
21.
Did the facility fail to have a actively certified operator in charge`?
❑ Yes�KNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
V0
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
TRNO
24•
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[ 0
'
: o viblatigrls, jr. iielF cjenci." rv�re )rioted• jlo.. frig f)ijs'vjsjt' • You will r; eegiye 04 Cutts
corres' otndence: about. this :visit: -
Comments (refer to question #): Explain any::YES anwers and/or, any recommendations or' any' ,oi tlier CDIIiiInt:ItS�'-', :r •"
Use drawings of facility to getter explain situations. (use additional pages as necessary}:
oo s,r
ar
14
Reviewer/Inspector Name r J-' D u' �I q v x17
Reviewer/Inspector Signatur . Date: 12 —a3 —!21r
3123199

Facility lumber: late o Inspection
Odor Issues
X.
Dues the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below es
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;� No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M No
VW
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes � No
30. Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ANO
31. Do the animals Feed storage bins fail to have appropriate cover? ❑ Yes ZNo
Do the flush tanks lack a submerged fill pipe or a permanent/lemporary cover`? -1n @g f7l
rttDual Comments; an orDrawings; ... (.. F.. F
0
,&1
J
3/23/99

0 Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
IRRoutine 0 Complaint 0 Follow-up of ❑WQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 3
Facility Number
Time of Inspection E= 24 hr. (hh:mm)
© Registered 1XCertified © Applied for Permit © Permitted JE3 Not Operational I Date last Operated:
FarmName :.......k� k �,.`..�........................................................................ County:....v��'41.11.h........................................... I.............
OwnerName....... c� .....`!s............................................................... Phone No: ............................... f...^`.... . .........................................
FacilityContact: .................................... r ................. Title: ............+.�...............d.........r.................. Phone No: ...................................... .............
Mailing Address:...9-3 ..... 1.�..... ..I..:5A...........C..l.!� ....I.F �.�L C........ra S .............. ..........................
Onhtte Representative—�Ls ILL Integrator:...
.1 .� ...................................
CertifiedOperator;............................................................................................................... Operator Certification Number:...................... ...................
Latitude �'�� �" Longitude
ign urrent ._, Design . Current... ; : . S^Designs :='.current' .F.
F.'
Swine capacity Population Poultry Capacity ` Population Cattle Capacity `Populatiot .
EJ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 1 a ❑ Non -Layer ❑Nan -Dairy
❑ Farrow to Wean ..... .... :...
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish ..'.
».. Total Design . apacity
❑ GiltsA.
........... .
_
❑ Boars
Total ssLw
Number of. Lagoons 1 Hpiding Ponds �.
❑Subsurface Drains Present
agoon Area
I0 Spray Field
Area
No Liquid Waste Management System
Vii
"en cal _
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
10 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
M No
c. If discharge is observed, what is the estimated flow in gaVmin?
M
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
❑ Yes
U4 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
14 No
4, Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
M No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
❑ Yes
t4 No
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
to No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
ANo
7/25/97

�llaellity Number:3
8. Are there lagoons or storage ponds on site which need to be properly closed?
5tmcturesoa ldin lush Pits tc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(ft):..................................................... •....... ................................... .....i,............................. ............... ,••...,.....i.
I0. Is seepage observed from any of the structures?
I t . is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
ar 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)
f J
15i Crop type ... may. ''` ,i.? {. °`...........................................................................................
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 reviewlinspection 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?
No.viulatioits nr deftcieneies:were noted•during this:visit:• You:►vin xecei ve'itd'ftirthei :
correspotidehce dh�out #his:visa#::: ' : ' ::: .
❑ Yes 0 No
❑ Yes 14 No
Structure 6
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes U�No
❑ Yes W No
❑ Yes '§4No
❑ Yes Rf No
❑ Yes ONo
❑ Yes 10 No
❑ Yes Uf No
❑ Yes O No
❑ Yes DI No
❑ Yes �3 No
❑ Yes to No
❑ Yes '0 No
:.::��..»�:., �::. .. ..x:•!: .. .:..- .. ...3!i'i.3iini.... .... ..i`.s::f i:......i.:,:sss•;.:...s..:..
Commt€s t�fer; a:. uetinn.# c'.' E Ialn an ,YE i'aasrverd/nran .,xendtitins:pr `ativ#tnt�t F:; '§'€
.. «.. a eiE..e... .. .. "' :iiC...
. ..I.S.......:.d....r...a....%..V..... 5:: (?le a I...f: 'l.�t.�3:.be.: T^�.€:jE.7:.ts l� lain:s.i,.t::.us::sa..t:. ian....s.»:'.'w. �i.. lS,e. aFI[I.l . ./}/ .'g. ■1 .. ,i.. ;,.. .s ... ....f.E.F.�.Ei.i.l:l:Swi`:::�s��li/� s:s.. F:.,i:l:!?hie ietb:'::..:.s.:S '€
fw,neca [iN€€"(t"-ie i'!iESs. �{_ �•€ e €f;F H. .;; ti i p
1■
.. ::�:. s....... s: .::€■
7/25/97

r
•ii'�
.�..,..a,,.:i:�,;:;,:�,..,��.:.........,;.:..`;,�;....,ls...,tis..::�.;,,,..,:..
.w.; ,,,,,ts ' a
«. S� '7,i'
�atPt,�;si'tl'l:s��•
... :s� .
�] Division of Soil and Water Conservation
[j Other Agency
^
Dif Water
vision ofQuality
.
�sE��:'
5 ,
...F:H,..'^^'."'?qi,"°°.+?x?«C'�..'...,"'.."!,,.,.,..,...ywirew^ ne+�.,,.,u�.`."3S3'..w.�w.nfpr'S^6!xi`?,T' ..—•i..
.. �
.'...
16 itoutine Q Com faint D Follow-up of MVQ inspection Q Follow-up or USLVC review � �U�Other
Date of Inspection--�—�'
Facility Number
Time of Inspcction � 24 hr. (hh:mm)
0 Registered © Certified © Applied for Permit 13 Permitted 10 Not t) crationaln Date Last Operated:
FarmName:............. llj..........r Ira .............................. County-:......1�.t!I.IJ....................................... .......................
Owner Name......... y. ►- i ....(nog) i5........,............................................................... Phone No:....�`��a�. °l�r. ��i-............................................
Facility Contact: ...... DQ.mij...... Adm-,t.rS.......... ............. Title:....... 011viia�.......�.............................. Phone No:.Cg1.0)Z-.jX.� 5P.4 .............
[.li.} Nfailing Address:....:1. .... Or3.....fY ...... ..... R+.+. �.......................... ...L'f !. ........ Ad ....................................... 957 ........
Onsite Representative :....D.0,1W....twniS............................................................ lntegrator:....F h�3........... h ....... ........................
} 1
Certified Operator: ........ ��ty.1p.1.i�........... .�tOAiS...................................................... Operator Certification Number ..........................................
Location of Farm:
Latitude �'�� �« Longitude
Design;1 .Current:::::.;,: Design ' € ..Current -Des
5witie Ca" acit Po ulation';
P. y=,. P..
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
i
Poultry Ca pncityi,"Poutllatiiin °Cattle!::'::.`'; Cap
❑ Layer
❑ Non -Layer
❑ Dairy
❑ Non -Dairy
❑ Other
S... Iii,:
;< D Total esigfn Ca city
.... .:
..
Total' SS1,
Ntiiteber of Lagoons I Hrslding Ps�nds ` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Ariiea
❑ No Liquid Waste Management System
,.., : ,,. ,:�:.. ' ... ..•. _. •:€t: .F ! .ail==€=:.:,s.,.' ., is�i;s;`
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [$No
2. Is any discharge observed from any part of the operation? ❑ Yes [31 No
Discharge originated at: ❑ Lagoon ❑ Spray Field [IOther
a. If discharge isobserved, was the conveyance. man-made? ❑ Yes 51 No
b. if discharge is observed, did it reacli Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated now in gal/min? ' IQ
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes $0 No
3. Is there evidence of past discharge from any part of the operation? N1 Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? Yes ❑ No
S. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ 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 [P No
7/25/97 Continued opt hack

t
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laizoons.Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft): ........... 13............... ................ ,................... ...................................
10. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed`?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes 55 No
❑ Yes 51 No
Structure 5 Structure 6
❑ Yes No
❑ Yes ® No
10 Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Aaste 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. Crap type ........... P1r.MV&.................. ......................................................imp-J!'Ji :1 iN....................................................................................................
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
M No
18. Does the receiving crop need improvement?
❑ Yes
$] No
19. Is there a lack of available waste application equipment?
❑ Yes
($j No
20. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21, Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22, Does record keeping need improvement?
12 Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
E No.violation�v' i deficiencie-s.werenoted during this:visit.-.You�will recei�e"no ftirther
Orrespyndeky about this:visit:•: :
-.. ..�.a '�•,� •:5�'... .. ::: � •... ..:::: . ..:.. ... ..:• . • ' ...: ...�..:-.. :::.:.::'. F... ..�. - ...:: i.:: �sSss•.•.e• .:.:. n•,•rLse•s..::.i.. .;:.....;s..:.»t,.;. ... ::: .. � ..»: F
„ » ..;��e: i:Fe?. s.F: ••::;Si: ';•�: i;:.- 3f F � 3'i
oments (refer:tu question #): E;Expiaix� arty :YES=answers:andlor.gny.rerbmnEenati[►ns or. g�ny:vther comnfs�;:E; .` `,i€i s;:
�F
iJs dt iwvlii s of Iacilit tn better ex lath sltuattom use iiddttiiitual ii es'�� tiecessu'� vy �{{}'�� �' ` ,;{;�; �� i� �F. § ' ��F�K�3 E � iFI i �
y„ ( C tt '"�) °' Eye ,{ 1 t ; $ FF{�S• 4:?
.p , 44i
iF • ; j, Fte •..' E( Yii `aCl•« ..eeiii. ,ii s. ' et i>�, ] .. yi.}: s 3 E ie •! P
. 9
3. Grou ltts i r. �i�+15�� lla �f tom• �(WS;r► Llcc�CS . �j D 15n� L.
4. ee s 1 or, �.rvimt� VLD
�. 0011 % o �� t151 OL" a 5 i'106 6 be 6) T If V
<'�Al C:shcj16 V*' � )6d .
1 X• �a.�- S�o� 5 �o�� b�. re�,re�o�.
I 4 I
`e�p rvUmfl�, XW C'4i1d n r4c% (�r-
Grv�s
� P .
7/25/97
_ ... �3a•w�31s .S�i.. ..i.ir •: "in ,.e+??'5n�en�t"i.�+ i K^,�—>•: .:�: 'S, ?
ff ..F .. Enid {j%
Reviewer/Inspector Name€. iF`.'.':#' E: ii':... .:i: :'. aK?'.. .S .. 36:. 4�a :!fET ;':! f
Reviewer/Inspector Signature: , r _. Date: Y

•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA ON SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:_-Y,
Mailing Address:
County: W
Integrator:
On Site Representative:
Physical Address/Location:
Phone:
Phone:
Type of Operation: S wine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
(,flpol,�
Latitude: �• „ Longitude: ' �' �" Elevation: __:_. eet
Circle Yes or No
Does'the Animal Waste Lagoon hap fficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) or No Aral Freeboard: =Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or o Was any erosion observed? Yes or o
Is adequate land available for spray? es or No I the cover crop adequate? or No
Crop(s) being utilized: �c r o�SurHr►:12.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings a or No '
100 Feet from Wells? ee or &
Z.
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes of
Is animal waste discharged into waters o e state by'man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated -on specific acre a with cov7j0,!27_P_,P
}7 Yes or No
Additional Comments: --- eJ ZDa_fz _�r!� �aAk
h eq.1 --
cc: Facility Assessment Unit = Use Attachments if Needed.

Site Requires Immediate Attention
•
•
Facility Number: 21 — d
SITE VISITATION RECORD
DATE: _-- `� — 2. rl 1995
Owner: DQ r+rA [ of L " m , L _-.. _ Farm Name:
County:
Agent Visiting Site: 6)� 4. � Phone: R -
Operator: Phone:
On Site Representative: Phone:
Physical Address: 0
Mailing Address:
Type of Operation:
Design Capacity:
Swine -�-- Poultry Cattle
Number of Animals on Site:
Latitude: 0 1" Longitude: a
Type of Inspection: Ground Aerial
Circle Yes or No
I }P
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: -1 Feet I Inches
For facilities with more than one lagoon, please address the other lagoons' Freeboard under the
comments section.
Was any seepage observed from the lagoons)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No is the cover crop adequate? Yes or No
Additional Comments:
Fax to [phone]
Signature of Agent