310575_INSPECTIONS_20171231

NUH I N UAHULINA
Department of Environmental W6

IS 7
Type of Visit: (.YCo=outine
Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 � Arrival Time: � Departure Time: Zf County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ���it I t4 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop. Wet Poultry
Layer
I iNon-Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
We22Lo Feeder
Dairy Calf
eder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
12,00
1-3 v9
D . P,oul
Layers
Design
Ga aci
Current
to
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ N NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ffNo ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: -- $ 75` Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 145-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes J ] o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, 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 FD 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 GT o ❑ 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?
❑ Yes
Q No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[/] N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F3 No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
�No
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ���es. No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 6<t�king ❑ 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 �0'N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J 'Yc ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: `3 ( - 7 ©ate of lns ection: Z
24. Did t$e facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Now❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-Iqo ❑ 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 D<o ❑ NA
B❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Er A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 04 ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
EA_No ❑ NA ❑ NE
FfNo ❑ NA ❑ NE
01Vo ❑ NA ❑ NE
Reviewer/Inspector Signatui
Page 3 of 3
Date:
21412015

Type of Visit: m C pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:'--i- County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
T Ltl o t-Integrator:
Latitude:
Phone:
Certification Number: 1 7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
can to Feeder
INon-Layer
Dairy Calf
Feeder to Finish
jP0
f 7-0
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Dry P,ouIt , C_a acity Pl©,
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
1 Other
Discharges and Stream Impacts
l . 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 [TNo ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes FrNo ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. fs 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
Identifier:
Spillway?: —�— —
Designed Freeboard (in):
Observed Freeboard (in): Q
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes eE2 '`10
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes . 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 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 ff 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 O No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Ej No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Ef'N_o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes eNoo
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o D NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E-No 0 NA ONE
the appropriate box(es) below.
Failure to complete annual sludge survey 0 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 ff No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No VfNA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No
Yes No
❑ Yes �No
❑ Yes �o
Yes NN7o
Yes [r, No
0 Yes �o
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA [] NE,
NA NE
NA NE
Reviewer/Inspector Signature: -r`r~ ��-._/� Date: S /C /
Page 3 of 3 21412014

Type of Visit: (rCompJiance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: O Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Z / Arrival Time: Departure Time: Q �County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:f U �U -fly Integrator:
Prone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design C►urrent Design C►urrent
Wet Paultey Capacity Pop. Cattle Capacity Pap.
Layer DairyCow
Wean to Feeder
Non -La er
DairyCalf
-"Feeder
to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent Cow
D , P,oul. Ca aci P,o P. Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Cj No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[—]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
)Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: 2
r
Waste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fTNo
❑ NA
❑ NE
a. lfyes, 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?: lji h
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E 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
❑ 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E!fNo
❑ 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
rj No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes n 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NIV
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
��No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ET'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections . ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dN
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili lNumber: jDate of Inspection: /T _
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 6No ❑ 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 E:fNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes E:rNo ❑ 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 O No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ENo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
[:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
d"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
allo
❑ 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).
-t-- _C ,P�n� �fl
a (i 1r� CPu S G
PJP w�►� t�'1�
t, �l c�a iP j.✓� `54— � f��n
V/4 Y,
'f {'
C-0
ReviewerAmpector Name:
Reviewer/Inspector Signature:
Page 3 of 3
it —I C V_'�'Q,;
Phone: 11 Q ;If 7.3 0 Y
Date: ✓ / S
214YI2014

Type of Visit: Q C pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: - Departure Time: County: '�lJ_ P(ZA) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Taw -
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: q1 9 3 a 4
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity MPop.
Wean to Finish FTLayer
Gattle E K@apacity
Dairy Cow
Design
Current
Pop.
Wean to Feeder
I jNon-Layer I E3
Design Current
D , Pioultr. Ca aci P,o
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 o
❑ Yes o
❑ Yes YNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: -51ED Date of inspection: 1 Ll J71
Waste Collection & Treatment -
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA G4 d tj
Spillway?: eS
Designed Freeboard (in):
Observed Freeboard (in): �j V
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 en ronmental 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 �fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �No
9. Does any part of the waste management system other than the waste structures require ❑Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [1No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zu, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
[�3 o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
es
No
❑ NA
❑ NE
20. Does the facility f ' to have all components of the CAWMP readily available? If yes, check
Yes
❑ No
❑ NA
❑ NE
the appropriate x.
WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes d No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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? ❑ Yeso ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jrNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: t 1
24, Did the facility fail to calibrate waste application equipment as required by the permit? El YesVNo
o ❑ NA ❑ NE
25. 9the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating'non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes ❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes EX/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?
/No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes L3
❑ 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 [21/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes MNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Eyes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Fd
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
se drawings of facility to better explain situations (use additional pages as necessary).
7,) .0Cw oN IJ e6 - fs REBuT-LDs1JG7 ­T6 aG 6061. # - Crime L4140
dc
lT c F'P2 roi,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
E.
Phonc: { r IOPU r 13
Date: i
21412011

31
Reason for Visit: Q'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: "t:'
Arrival Time: /,$'" Departure Time: D Q O County: 'D1P42!�j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: a-AMQOl, N'4XP:_ZEL.Q Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
@apaelty Pop.
Design Current
Wet PoulY15—acit-VIER.O.p.
[Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
J 2-tfb (o
Design Current
Di P,o
La ers
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Bmod Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili dumber: 3 -51 r Date of Inspection: z
WasW Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
[3/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: LA6071i
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
6 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 � o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 0"'
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes bNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If 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
o
r
❑ 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
[—]Yes
�rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
fNo
❑ 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.
❑WCTP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Q Vo ❑ 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 [3) o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDateof Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [/] N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I! No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes O No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes [2/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? [:]Yes E No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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 Pl o ❑ NA ONE
❑ Yes 21"No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
EJ�N❑ NA ❑ NE
❑ NA 0 NE
rN9
❑ 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).
nIEC-Q7 KEE,P CaPv aF 6CC W17h fps.
SSG tq 'i C i, Wue.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (910 q% --1si
Date: 1 24 ( /a
21412011

(Type of Visit: 0 rRoutine
liance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: Departure Time: County: :Ck1P Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: L. iY4� i \ 6t1c� F ' Integrator:
Phone:
Certified Operator: Certification Number: �2 0 I;L+
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design C►urrent Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Da' Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
DairyHeifer
Design CEll
urrent D Cow
Dr, P,oult , Ca al i P,o Non -Da'
try
ILayers I Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[3 Yes
[] No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Contdnued

Facili Number: - Date of Inspection: t
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 1� Structure 2 Structure 3
Identifier: LA
L
Spillway?:
Designed Freeboard (in):
Structure 4 Structure 5
[No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
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.)
/No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance 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
V1�6
❑ NA
[3 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
c
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Noo
❑ NA
❑ NE
R_ wired Records & Documents
�No❑
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�70
❑ 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 Ca4. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesVNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: I - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
[]NA ❑NE
To NA ' ❑ NE
26. Did the facility fail 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 VNo ❑ 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 To ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes aeo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes <o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L2r<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ; Rio ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date
F
r, L✓
21412011

sl
Type of Visitpliance Inspection O Operation Review O Structure Evaluation C) Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: t Z,o ►ti Arrival Time: 9 5 Departure Time: County: 001P L) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ES 2~6JS E
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = c = Longitude: = n = 6 =
Design Current
Design C►urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle
Capacity Population
❑ Wean to Finish
❑ Layer ❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish 1 15Q
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
El Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
El Beef Feeder
❑ Beef Brood Coxq
❑ Boars
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other I
Number of Structures: 1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E16No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
Page I of 3
12128104 Continu,

Date of Inspection
Facility Number: 31 — S S
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: (ACrdup)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E�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
UNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit?
❑ Yes
ENo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
�,/
Ld No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
0 ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E� No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
°Comments (refer to question°#) Ex.'.plain any YESanswers and/or any recommendations or, any otliercomments
a ,""e* "-
Use drawings of facility to better explain situations. (use additional pages as necessary}: w.
Ta 7A16 SL-UDG E Sue-JC. 3oDA 5. +
is eA_-o 20 to S q—rL TGSr 3 o D iA 4 S ,
Reviewer/Inspector Name voH>;1..� , . :.0 � �� Phone: lb
Reviewer/Inspector Signature Date: I I -Lo ti
Wage 2 of 3 1 L1L6w4 uonnnuea

facility Number: Date of Inspection t 7o t
Required Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
2 L Does record keeping need improvement? If yes, check the appropriate Zoil
elow. a Yes ❑ No ❑ NA El NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes ,(No El NA El NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes LI No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes E(No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ('Yes El No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes L�No [I NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [2 No ❑ NA ❑ NE
Other issues ,-,,�"
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes I* �o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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
, ,(
LI 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
6No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
T
Page 3 of 3
12128104

Type of visit (0 �C,/ompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit tO Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ti tp Arrival Time: Departure Time: County: DADL� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: '_� H wv_5 'RUOSG Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 5 = Longitude: = ° = , = "
MDesignCurrent Design Curren
Dgnrentineopulation
Wet Poultry Capacity Population Cattle
Capacity
Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er ❑ DairyCalf
❑ Dai Heifer
Feeder to Finish
O
cso
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑Non -La ers❑
❑Beef Feeder
EGilts
Boars
Pullets
❑Beef Brood Co
❑ Turke s
Other
❑ Turke Points
❑ Other
❑ Other Number of Structures:
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
❑ o
❑ Yes
Zo
❑ NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
dNo ❑ 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): 29
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
dNo ❑ 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
environmental7eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
[3/NNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Eyhlo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo 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.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0�`No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2/No
❑ NA
❑ NE
Reviewer/inspector Name 1. - d �A2N Phone: 9 io (, 3%'g
Reviewer/Inspector Signature: Date: i I -x.A I
rage -, of s fZriaruy Uu rt8nueu

y Facility Number: 3 —S Date of Inspection { o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections.
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
,/❑
L_�J1,/No
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L3No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,2f/No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the perm
❑ Yes
L(it? NNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L'! No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EI/No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�(
LI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ffNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
CNo
❑ NA
❑ NE
12128104

Type of Visit 6
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Qf Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑Denied Access
Date of Visit: Arrival Time: 15 Departure Time: County: aVP��-{`� Region:
Farm Name:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative:y ACMES KOO$ E I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' 0 Longitude: 0 ° =' =
Design Current
Swine Capac11
ity Population
�Designc.,rrentgill
Wet Poultry C►apacity
Population
Design C•ttrrent
C*attle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish I lAm
WIS,
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry PoultrJ
❑ Layers
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
Gilts ❑ Non -Layers
❑ Pullets
pBoars
❑ Turkeys
Other ❑ Turkey Poults
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E!rNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Page l of 3 12128104 Continued

Facility Number: 31 —5'7 S Date of Inspection S o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
[[Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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?
El Yes
,_,/
L7 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
��!!
Eko
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�(No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
C3"No
❑ NA
❑ NE
Additional Continents and/or Drawings:'
Page 3 of 3 12128104

Facility Number: 3 —sus Date of Inspection 3 09
WCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jNo ❑ 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: LA erav'+J I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): So
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [2No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes L No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
k�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L3'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
[ZNo
❑ NA
❑ NE
show _.n_R-L b ct- z ao KBOW A PR_m CA T Xz J J,
ADO C ZV J Si.J16 2oT,aT j , Be S O R-c SEn.ID
C 4 P q ro 2At✓E 1>l-b OPP t,,�1M,yam/Ci Ta ,J 2CG M+J At, 6 ('r ME,
Reviewer/Inspector Name a QW-A*1 Phone: 1"9JJ 79&-23��
Reviewer/Inspector Signature: CL&Date: 141g 105
Poee 2 of 3 12128104 Continued

Facility Number: 31 -515 1 Date of Inspection
WaT Collection & Treatment
dNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: LA OcUPJ t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SG
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
[2 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
2f 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
UrNo
❑ 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
ZI.) NE-E9 To S llo rtf�-L o c..t' 1.007t 030 APM-M t4TZ4OJ.
Ij e W i J t� 6 �A )fir 1i01�1 rG Ir6 D D i l�-� L��16 Z4-TAT , R E S U
"Le
E 4WD 1_46 t -I'l�t r,l �t -ra +J P� G +,J A t✓ 6 (Y F'C_E.
Reviewer/Inspector Name I - --- - -- G -� ArL/�! -- - -I Phone: C910) -74
Reviewer/Inspector Signature: Date: q l= jag
Pape 2 of 3 I2128104 Continued

Facility Number 31 Sys
Q Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
lType of Visit 6 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit ORoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /S Departure Time: County: IR Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: JAMtF.s r�d�sE Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = f = Longitude: 0 ° = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La es
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
17Zak
11100
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current-
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Coyd
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CTNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
El NE
❑ Yes
WN'o
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection Y o
Wfiste 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: GA
Spillway?:
Designed Freeboard (in): It 3
Observed Freeboard (in): ?j�J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
LI 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
ENo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
6 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
(j 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
WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0 No ❑ NA ❑ NE
maintenance/improvement?
H . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
D NO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soii
❑ 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
I!I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E,j No
[I NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
l d NNo
❑ 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
WNo
❑ NA
❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
COPY '0f zoor OXC
24) FAA
Reviewer[inspector Name p e Phone: y� h - 3K
Reviewer/Inspector Signature:4mal—LDate: o
1L/66/U4 uonunuea

.a
Facility Number: j —SAS Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑ rut, er
21. Does record keeping need improvement? If yes, check the appropriate box below. LJ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ 7Crop
ly Freeboard ❑ Waste Analysis El Soil Analysis ❑ Waste Transfers El Annual Certification
❑ Rainfall El Stocking Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ld No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �ENo ❑ NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes ETNo ❑ NA ❑ NE
❑ Yes �N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Y
[ Ko El NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
Yes
❑ No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No -E:fNA
❑ NE
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 concem?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
En
❑ NA
❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ICJ No ❑ NA ❑ NE
12128104

_ Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit �C(ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C� Routine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: (A ZO o 'Arrival Time: Qli Departure Time: County: p Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: JAM -.S ZUS E
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
ini
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c Q 6 =, Longitude: = c = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I t�.
E]Non-La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharees & 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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: , I
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 O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
}Z o
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128104 Continued

Facility Number: -Sig Date of Inspection ->A
1
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?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA600P1
Spillway?: yes
Designed Freeboard (in): K.S
Observed Freeboard (in): 31
No ❑ NA ❑ NE
dNo ❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
through a waste management or closure plan?
Structure 6
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 I� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2J 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
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L4'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):
:LQ UPDAT6 C (U f `'IeL9 rd PL AA .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: (y/
Date: ~
r �i�Qin,r
oI
/`i. a. fi s� ■�n�

Facility Number: — S7 S Date of Inspection 1 (0,224667
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 appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ WeIQ Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ElAnnual Certification
ElRainfall ❑ 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?
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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes CNo ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes O'1Go ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No 2'1'A ❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
�Eh'4'oo
2<
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
UNo
❑ NA
❑ NE
12128104

r/
Facility Number 3 1 S
a Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance 1
Reason for Visit �1 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 7 O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: �AMF_t jot}-f E Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
{
Design Current
Swine Capacity Population
.` ❑ Wean to Finish
T
❑ Wean to Feeder
® Feeder to Finish d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other -
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = r Longitude: ❑ ° ❑ 1 = "
Design Current .
Wet Poultry Capacity Population Cattle
❑ La er
❑ Non -La er
DryPoultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
s❑
Vurkre
Pouets
❑
Discharees & 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 .:'
Capacity'
❑ Dai Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
h
Number of Structures: 6A 1'7r� o
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page/ of 3
❑ Yes in ❑ NA ❑ NE
El Yes
El No
El NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El No
El Yes
L"INo
El NA
❑NE
❑ Yes
04
❑ NA
❑ NE
12128104 Continued

F�
Facility Number: — 51 S
Date of Inspection d V
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier:
I -A G cralJ
Spillway?:
`i es
Designed Freeboard (in):
l ci . S
Observed Freeboard (in):
3 1
Structure 3
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
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 0No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th eat, 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 EJ/No []NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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. Croptype(s) W1i&_A-'r '5W-?GGW
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7o El NA El NE
o ❑ NA ❑ NE
E No ❑ NA ❑ NE
IJ No ❑ NA ❑ NE
C4o ❑ NA ❑ NE
Comments (refer to question #): Explain any YESanswersand/or any recommendations. or, :any othercomments
Use drawings of facility to better explain situations. use additional pages as necessary):
FAO-.&. AND iZEco"s
L'V* V r - G-M 0.
Reviewer/Inspector Name -- ���} u-t'- Phone:9
Reviewer/Inspector Signature: g&��Date: a-D aG
Page 2 of j 12128104 C,'onfinued

1/
Facility Number: 31 — 57,f Date of Inspection oG
•j
Reguired Records & Documents
19. Did the facility fail to have 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 ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
IJ Yes
94o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking [306rop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E]
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
Zo❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No � A
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No WNNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�Z_❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No �NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CI No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
l j<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?
El Yes
��
Lf 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
ffNo
❑ 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
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Q.Compiiance Inspection
Reason for Visit 'Routine O Complaint
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Timed /.'
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Departure Time: County: to Region:
Facility Contact: Title:
Onsite Representative: _7G rna rl S P/
Certified Operator:
Back-up Operator:
"caner Email:
Phone:
Phone No:
Integrator: r _ _-_ CJt'_3C"r�
cj---
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ' = Longitude: 0 ° 0
Design
Swine @apacity
Current Design
Population Wet Poultry Capacity
Current Design Current
Population Cattle Capacity Popg lattio�n
❑Dai Cow
I❑Dai Calf
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
1
110 Non -Layer I
eeder to Finish
Farrow to Wean
i
Dry Poultry
❑ Dairy Heifer
E]Dry Cow
ElNon-Dairy
El Beef Stocker
� ❑Beef Feeder
❑ Beef Brood Cowl
-
Number o€Structures:
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Gilts
❑Non -La Non -Layers
El Pullets
❑ Boars
Othe
❑ Turke s
U ey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes e'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 E'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes _IEMo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ 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: I
Spillway?:�
Designed Freeboard (in): l
Observed Freeboard (in): 3j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V3'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 _2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes . 5-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 r. No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes.
."No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
11 2�-LaXZ41S �
Q'lG�r C
Reviewer/Inspector Name Phone: 4 rs
Reviewer/Inspector Signature: Date: v� O
12128104 Continued

Facility Number: 3 Date of Inspection rl
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O,Io ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -ffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes *o �NA El. -NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA of NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA P NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ,;'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
F,�
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2-No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
eENo
❑ 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
2Mo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ENo
❑ NA
❑ NE
12128104

Type of Visit OrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f6 Routine Q Complaint O Fallow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit: /O Time' 4D
O Not Operational Q Below Threshold
OPermitted [3 Certified ❑ Conditionall Cerdfied � egistered Date -Last Operated
�r Above Threshold: .... _ ..
Farm Name: � t/S County:
Owner Name: Z_ Phone No:
Mailing Address:
Facility Contact: _ . _ „ ..._ . _ _... Title:.._ . Phone No! _ - -- � Onsite Representative-��i��L Integrator. �j_10
Certified Operator.
Location of Farm:
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ House Latitude • " Longitude • 4
Swine
- Wean to Feeder
Feeder to Finish
IL
Farrow to Wean
EFarrow to Feeder
In Farrow to Finish
Boars
Other
u1
Discharges 8 StreaiaImpacts
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?
_ Desgn � �Clnrre�tt:
ahob
4
.t
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
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JR No
❑ Yes gNo
❑ Yes XNo
Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

f FaQility Number_ 5 j� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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 ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an Iz
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes JO No
8. Does any part of the waste management system other than waste structures require maintenanceJunprovement? ❑ Yes JO No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes O No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop type �]
13. Do the receiving crops differ with thos4 designated in the Certified Animal Waste Management Plan (CA%e)? ❑ Yes ❑'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ONo
16. Is there a lack of adequate waste application equipment? ❑ Yes VfNo
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ZoNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes rNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 7No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ yes ;dNo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
/Mad
/
/yW# ;Z�J 5,aeOrr_01�)
Reviewer/Inspector Name
Reviewer/Iuspector Signature:
Date:
IZ/1-1iul conunuea

Facifrty Number:
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25_ Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
❑ Yes A No
❑ Yes 9No
❑ Yes (INo
❑ Yes ONo
❑ Yes ONo
❑ Yes PNo
❑ Yes PNo
❑ Yes 9No
❑ Yes �No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
l2/l2/03

r
vtston of Water4ahtyr
of Soto aad Water C°nservati a ;
of Visit
Reason for
Inspection O Operation Review Q Lagoon Evaluation
Routine O Complaint Q Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified [3 Conditi/ona�lly, jCertified [3 Registered
Farm Name: .. !i. �` ........... /t l
Q...... ..... .....1........
OwnerName:..... .......... K.. ,........ .... ..04e;:!..................................
ElTime:
Not Operational O Below
Date Last Operated or Above Threshold: ......_. �....
County: ..... ................'J'!.
PhoneNo: ................ . ..... ..... ...... ............. ...... ... ». ....»� .
FacilityContact: ............................................................................... Title:................................................................ Phone No:......................................,............
MailingAddress:........................................................ .................... ..........................I.....W....... ................_. .......................
Onsite Representative:... � �i� 5� ............. Integrator. � w I( l..i!� ..___............
�•
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �4 6C Longitude �• �� �«
Des�gn; Current ign DesCurrent Design , Current
_S--_w"inPhy..
C-
on z. Catd
_-.. Cast, uii ac-iae Ca act Po "iiilation ,;;
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean : -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Tom SSLW
- - Numbec�of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area JE3 Spray Field Area _
Holding Ponds! Solid Traps - ,' ❑ No Liquid Waste Management System t
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes/�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes X No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ITo
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 6/
Identifier: ...............................................................................................
Freeboard (inches): ?.r
5100 Continued on back

r.
IL
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
9No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T 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
)dNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste A lication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONo
11. Is there evidence over application? El Excessive Ponding El PAN El Hydraulic Overload
El Yes
�No
12. Crop type S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
PNo
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
!140
16. Is there a lack of adequate waste application equipment?
❑ Yes
`L ,�
No
Required Records &_ Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ZfN,
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
O.-No
19. Does record keeping need improvement? (iel 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
YNo
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
No
24. Does facility require a foilow-up visit by same agency?
❑ Yes
o
tNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
iCominents (refertoiquestto'n #�? ;Explamany YES answersand/or a'ny recoumeudahons orany}© het 'conients;ti
%a
1°acil� to better ex [atn st
Use drawn s of tuahons. (use addttionalpages as necessary) al Notes
g a tyr.. �' Field CapY ❑Fin z
. -k _. , ' .
71tw /Uo r :_7�
aol
GF_ VF L
i
Reviewer/Inspector Name F 7
Reviewer/Inspector Signature:
Date:
05103101 v 1 Continued

. . . <�
Facility Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �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 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Additional ornments and/orDrawings:
74
141,
5100

. � DevtSlOf�i of Water akty
r Q Drsron of Sod and Water Conservation
n{ r
r w D.Other Agency € 5 �H"•
Type of Visit � Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit (It Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: t? Tune: 9 ! Printed on: 7/21/2000
Facility Number i S
Q Not Operational Q Below Threshold
© Permitted $ Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ................
r
Farm Name: .�14+�65 �![I# � ovsE f1 �2M County: .D(,1p4!4............ Me..!f .............................
Owner Name:..-�f?!!<Fi ..... B..4..TT "/ O u,,�E..-------...... Phone No:. °7vro� .,����P ..- 43 %,a�.........................
----
Facility Contact: ........
Title:
Phone No:
Mailing Address: 8�9....L ��?Q.!'.L�..�1�� .............................. ��!v-SlP..!Pl.N��/,5..... �t-j—/;.-A85`7B
Onsite Representative:.��i''4MFst5 !!� M!<4DUS6 Integrator: ..rC..c�!y,Qi4.ei4
Certified Operator: ..... s!Im65................................. Operator Certification Number:..-.. .6�a
...................
Location of Farm:
A.
MIR rH mF Ou r4 4 �s 8a r dq c . of w f sib o� .SR l S3 � IV - 5'. tJ to rA 0 �� /53,3 I
Swine 0 Poultry ❑ Cattle ❑ Horse Latitude 0 L i° Longitude 0 & 94
Design Current
Design Current
Design Current
Swine Cal!acity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
ILI Layer
1
❑ Dairy
Feeder to Finish
Ido p
11do
10 Non -Layer
1
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
10 Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
Total SSLW
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present 110 Lag -on Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
E'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance man-made?
❑Yes
❑ No
b. If dischar-e is observed. did it reach Water of the State'? (If yes, notify DWQ)
El Yes
❑ No
c. If dischanze is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑Yes
j4No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
D�40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway
❑ Yes
❑ No
Slrm:turc I Structure 2 Structure ; Structure 4 Structure 5
Structure 6
Of/
identifier : .............. ............. I...... .........................
Freehoard (inches):
5100
Continued
on hack

- Facilisy Number: — !late of .faspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 4 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �'No
(If any of questions 4-6 was answered yes, and the situation poses an R
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes "I'
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 4No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 3<"No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes *0
12. Crop type -TA Wdq"T
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes qNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Dpo
b) Does the facility need a wettable acre determination? ❑ Yes JVNo
c) This facility is pended for a wettable acre determination? ❑ Yes ❑'No
15. Does the receiving crop need improvement?
❑ Yes
M,No _
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ro
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Nri
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)
El Yes
lo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
�To
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
�
(ie/ discharge, freeboard problems, over application) Al
%%
❑Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
[No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Kio
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
. • N•yiola(igres:or• deftcie"ncieg were noted• during fhis:visit: - Yo.Wwill r666e f further
corresp©ridence.aboutthis 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):
g t YE 1 r*CED Good'- ko- coot as WELL- kglo '
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: :�)r Doee / Date: 5100

1Facii'tty Number: l —S j Date of Imspection /O yy Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge �Vor below ❑ Yes VNo'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 02rNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P'No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes do
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JkNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 1�00
5/00

Division of Soil and Wat+ r Conservation =-Operation Review
'
a El Division of Soil anaterd WConservation .`Compliance )nspecti o h a `�
Division of�Water QualRty _Compliance Inspection r = -
F x r
Ot&er Aon gency OperahRevrew
Routine O Complaint Q Follow-uE of DWQ inspection 0 Follow-up of DSWC review Q Other
Facility Number Date of inspection
'Time of Inspection �.'� 24 hr. (hh:mm)
[3 Permitted U Certified [3 Conditionally Certified [3 Registered 0 Not O erational Date Last Operated:
Farm N. ....C!i:..........G•�1� County: ...... ........ y ... ............. .......................
Owner Name:
Facility Contact: .............................................................................. Title:
Flailing Address:
Onsite Representative: ...... ...•
Certified Operator: .............
Location of Farm:
:.......... ..... Phone No: .........
............................. .......... ....... I .... - Phone No:.. .................
..................................................................................... ..........................
Integrator:.... ... ...............................
Operator Certification Number
r.............................................................. ........ ..........� F
Latitude �•�° �•�- Longitude C�• �` ���
Design Current.
Swine-, ..2? .: '= .; ,, Ca acity Population
❑ Wean to Feeder
Weeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Giltsc
❑ Boars
Number of Lagoons. ❑ Subsurface Drains Present ❑ Lagoon Area I [] Spray Field Area
Holdtng:Ponds'/Sglid Traps .- ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J 'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? (Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (� �}
Freeboard (inches): _- ............ ................................... ............................. ................................... ........................................ I ............... .............
.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23199 Continued on back

'acility Number: — S Date aff Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
XNo
(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
gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
'KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11. Is there evidence of ver application? ❑ Excessive Ponding ❑ PAN
❑ Yes
KNo
12. Crop type � S�
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
M'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes NNo
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 WNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Id 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 ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes IRNo
24. Does Facility require a follow-up visit by same agency? []Yes ,'=`j No
25. Were any additional problems noted which cabse noncompliance of the Certified AWMP? ❑ Yes -19 No
ivQ VIOialf�On5.00 defiCleliCiCS WE're ilOt d dirz'Eng xhi'.vl51t, • Y64 'will •feeeiye iio further
COrre'sAolidenCea"b6UAthis'Visit_'.'.'.'..... ..... ...'......
.'.'.'.'.
comments (refer t6. question; #) -Explain anyYES attswers and/or any recornm&ndations or aayotlier comments: _
Use drawings of facility to better_`explamsituations (use additi"al-page§"as=necessary) _
_e _.
V &V j �� �� t
\ C
e, lf�& L—A —D. e— rcj ft 4-1 ;jk �,
3/23/99

r
acHity Number:'3 — ! Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
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
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
P,No
Additional, omments_an or carvings:
__-
3/23/99

-h M ,:. 4..• '-3:.,. wa.w.z•,�• >: --�:.-.�����1e:.,��, :�.�.a':;�.. `�::. � __-.:�. d7.,S xt �'�x ,�---«�` ��- "€
Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
Routine 0 Complaint O Follow-up of DW2 inspection 0 Follow-up (if DSWC review 0 Other
Date of Inspection
Facility Number Time of Inspection =1U 24 hr. (hh:mm)
© Registered P Certified 13 Applied for Permit © Permitted 0 Not Operation Date Last Operated:
Farm Name: } n r •• �Ar.,,. ..................................... County: ....... NL.�\ti..............................................................
OwnerName :................ tS...... 4 ................11.................................. Phone `'o:.. �)....... . .... .Z.........................
Facility Contact:.................................................................... ..... Title: ....... Phone No:
Mailing Address: ...... t.$5n........... LsWCJL.Jzf .......................................................... ...... Uu.,....5Po.:J..... t.J..cw............................ ..z 1 ..... -
Onsite Representative:..................o�,a5........... J. ............................................. integrator: g c�...........l4ctsrcl ..... �- ...
Certified Operator;............................................................................................................... Operator Certification Number:..................
Location of Farm:
.....�ti. .S......�Et ........... '.x+.....�?e.S. Sa1r?c...... er.......K.......$.... Z a.............I.5`3S....................................................................................
.......... .... ........ ... _. _.. .. .... .. ..... ............ ..... ..........................................
Latitude ' " Longitude =• =` "
CDnDsi Current Current urent''
"
Smote _ Capacity Popylataon Poultry s Capacitys Population Cattle V apacrty Population
❑ Wean to Feeder ; ❑ Layer Dairy
Feeder to Finish l Zoc) 12 DO ❑ Non -Layer
❑ Farrow to Wean
`41ee
❑ Farrow to Feeder ❑Other ❑ Farrow to Finish Total Design Capacity a
❑ Gilts
❑ Soars T
,. s� ...
Dial SSLW h
Ntunbet of Lagoons / Haldtng=Ponds �, ❑ Subsurface Drains Present ❑ ❑ Lagoon Area Spray Field Area
<° :.
❑ No Liquid Waste Management System '• b
y
I Is
❑ Non -Dairy
❑
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 5No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes (� No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) El Yes [Z No
c. If discharge is observed, what is the estimated flow in gal/min?MIA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes M No
3. Is there evidence of past discharge from any part of the operation? El Yes 1A No
4. Were there any adverse impacts to the waters of the State other than from a discharge? [:I Yes [4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require El Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes j No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Fac;H*y Number: J( 57.
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes P No
Structures_(Lagogns,H,olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes lP No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard (tt):........... ...... ........ ................................... .........
...................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
0No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .................. .Comm...------•......WV.............. ?��� ................ --..-..---...................................................-----.-..------.-.----.-.--.......................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
El No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[BNo
18.
Does the receiving crop need improvement?
[�) Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
f9 No
21.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
[&No
22.
Does record keeping need improvement?
1591yes
❑ No
For Certified or Pernvtted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
O 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
0- No:violatioas-or deficieincies'were-noted•during this 'visit'., Yo'U4411 receive-no•furttier
:. eorrtsp0 de11ce A out thKvisit.• : : :. :.: ,: , :
�z_ �r05;ss� p++C S On invur J�1� WG t� S�wvl0 be 14illt v�R_ CI �-reseedeJ. $a,�
b��u. (a
���cdaer Mtxea- Sov �2 C�r��Qg� �vf !x[C1x�cf.
°14�
zz. Cvrv-c-� PAN �a�. i.0 V1 Shol �� b4 LO-�AJ on �� ►eco,�z. SP r�urrt�= s�u�r} 6e
iww�N—r Uszen � C-T,,t� ac.rccr, Rqrk- e.-� �u{4 a,tL, CC,(CLJ&
7/25/97
Reviewer/Inspector Name
n
Reviewer/Inspector Signature:
Date: I & /f-

¢� s zu Division of Soil and Water Conservation ❑ Other Agency
..
Division of Water Quality
jam, Routine O Complaint O Follo,�r--up of I)«-Q inspc-tion O Fotlow-up of [)SWC review O Other
Date of Inspection 1
Facility Number 3 17S
Time of Inspection ! 24 hr. (hh:mm)
Registered © Certified © Applied for Permit © Permitted JMNot O crational Date Last Operated
Farm Name: ..... 1QU.s.r ......... .Zvp?................... Count D p)` .........
Owner Name: ......diLM .S.....�av ..6a....... R.U.S.t........................................ Phone No:...�`lli�. u`lr.. 7ir.................................
Facility Contact:..... 3.w,a.S....�...6r E-a oze--. Title ...,,&WAY........................................... Phone No:..�{`..fR1��.'.�7.�....
Mailing Address:.... g...... L.►I01.1-1-7V....................... ............................ ............ ...... J
�... 1.-�.L................. ......
Onsite Representative . ..... �.5.....&7&.......Z..&.............................. Integrator:.....:.. ..4.-Hrolb,.................................
.................... . Certified Operator:. j4km ...... $ _..........�8,,'rw................................................ Operator Certification Number: z—al-7.1 .................
Location of Farm:
11.1..ilC.�+................
r�.rr.....>n bri......!'.:....Faarm......__..r,.l��....t+.�,.....�c....S.t.ii�C-..� of ...................................................... PW
Latitude Longitude �• �� ���
a DestgnCurrent
Design Current- Design Current
-, i .. Aswe a Capacity ,]Papulatton ° Pou or[try,-rty _ Capae:Population:, Cattle "_. Cap„acrty P�ptrlationz`
❑ Wean to Feeder
❑ Layer
El Dairy
Feeder to Finish
j,�
❑Non -Layer
❑Non -Dairy
❑ Farrow to Wean
Y
�'..
"
❑ Farrow to Feeder
❑ Other *_ t
Total Design _Capacity^
❑Farrow to Finish
❑ Gilts
ry
❑ Boars
�
4 T�ta1 SSLW `
L 1000
Number of Lagoons E Holding>ponds.0; ❑ Subsurface Drains Presen !J10Lagoon Area JCISpray Field Area
❑ No Liquid Waste Management System,`.
..
General
1. Are there any buffers that need maintenancelimprovement?
5a Yes
0 No
2. Is any discharge observed from any part of the operation?
❑ Yes
MNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. if discharge is observed, what is the estimated flow in Uallmin?
-d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑Yes
[29 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
MNo
4_ Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
§allo
5. 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
(M No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
09 No
7/25/97
Continued oi: back

J Facility Number: 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
r
Structures (Lag_oOns,Ilolding. Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................................... .........I— ......... ....... I. ..................... I............. ... I.........................
Freeboard(ft): ........... Z................................................................................................................................... ....................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...G 6Y'y.................r.1. . i................. GF.1�.A. w........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• No.violitions-or delffciencies were noted during this:visit:. 'You :win receive•i o' -further-: "
-;-eorrespQndence.aboutthis�visit:-:�;�;�: .-.: ..,.�..:.....� ;.:-.:.
❑ Yes [ZNo
❑ Yes PNo
Structure 6
❑ Yes (�lNo
❑ Yes ® No
15 Yes ❑ No
❑ Yes 5a No
❑ Yes 10 No
❑ Yes A No
❑ Yes 5Q No
t4Yes ❑ No
QX Yes ❑ No
PYes
❑ No
❑ Yes
E,No
Yes
(I No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
1. Ouf} tV_' thWld be. e-,W AO Ojv vntj S ray itel js , Ak
s, Fe1a )1Jd- 5,6u)6 b,-_ +Ope ass covkVJc
y- cev�-4 tt(a". A wp F4 e
l - + 40 be. �i& . r1 Cy
I9. T!VmAy— {c ;r% p vac,QSS 4 PVYL taLS,�r� n�i�piBtAi 9uti 4'l�Lt,�-
1-2- ra�^rn jr% tMcK< o Ccr�i i[ATjM- �v0 Spry �CLOr�L Owe -Oh �LA o ��
fow�s �u i�� 7 tr- 5 �� rccard5 sGroJ(d l4pf pu 1 ntlrr�per4d number
7/25/97

3d—67_5�
•
Site Requires Immediate Attention:
Facility No.,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: /I , 1995
Time:
Farm Name/Owns
Mailing Address:
County:
Integrator. _i A 9g � _,. Phone:
On Site Representative: Phone: 7
Physical Address/Location: Wzo. i5t—
Type of Operation: Swine. 6"'� - Poultry Cattle
Design Capacity: /-1 b b Number of Animals on Site: _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:Lon gitude;{Z' Elevation:' Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) &or No Actual Freeboard: "? Ft. Inches
Was any seepage observed from the lagoon(s)? Yes od Was any erosion observed? Yes or Ino
Is adequate land available for spray?_ffe) or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: - 4 _
Does the facility meet SCS minimum setback criteria? 20 Feet from Dwellings? ;� or No
100 Feet from Wells? 'e or No
Is the animal waste stockpiled within 100'Feet of USGS Blue Line Stream? Yes o9S)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on sl
Additional Comments: .
174o u/Wf r— 1h
with cover crop)? Yes or No
J f / 1 0
Inspector Name
Signature
M
cc: Facility Assessment Unit
Use Attachments if Needed.