310639_INSPECTIONS_20171231

NUH 1 H UAHULINA
Department of Environmental Qual

Type of Visit: QrCo�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '] Arrival Time:--LL� Departure Time: EZ= County:31,'Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: WS:L ]P' n j 2� Q Integrator:
Certification Number: +1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design C«urrent
Swine C**specify Pop. Wet Poultry
Wean to Finish Layer
Design Current
C►►specify Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder D . P,oul
Farrow to Finish Layers
Design Current
C_a aci P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes ZNo ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [:]No
[:]Yes ❑ ])lo
❑ Yes N
❑ Yes 90
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA NE
❑NA ❑NE
❑NA ONE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C�J/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA D NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(70txJ I [ - Z' tAG�Zb3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ 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 [;a No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 7, ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
Q No
'o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZWN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yeso
❑ 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
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
YNo.
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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

F cifi Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eo ❑ NA ❑ NE
25. Is the facility'out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ' No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2(No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
Ko
�o
[�No
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
(Comments {refer to question ft Explain any YES answers and/or. any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
0PI0 �-R(zo,
Phone: ( ! 1A )?71-13 gg
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 21412015

Type of Visit: Q Co pliance Inspection 0 Operation Review Q 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: ® County: DW?V-uJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: %R.i. Oom"CS _ Integrator:
Certified Operator:
Certification Number: l 17LA is
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dai Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Curren#
Dr., P.oultr Ca .aci P,o ,
Layers
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey POURS
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑Yes Li ❑ 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 l of 3 21412015 Continued

Facility Number: jDate of Inspection:
I�
Waste Collection & Treatment
4. Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ 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: LACStW41 cAcmtj Z 06twmZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes YNo
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [f 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ 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 Ui No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F�, 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes &No
❑ Yes RI No
❑ Yes No
❑ Yes 9No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
❑ Yes E6No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? El Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Ins ection-
J
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25.E Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes jNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
F6 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dj� o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatun
Page 3 of 3
Phone. 0i0 17b ' l w
Date: a3
21412015

Type of Visit: g) Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: ; Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: W�.QrAM h)0P=j ;= Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: [ n TI L
Certification Number:
Longitude:
Wean to Finish I I
11-ayer
I
I Dairy
Wean to Feeder
Non -La er
Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D . P■oultr, Ca aci_ Pao
Dairy er
Non -Dairy
Farrow to Finish
Layers
erGilts
Non -La ers
erBoars
Pullets
d Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection:
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 I Structure 2 Structure 3 Structure 4
Identifier: LA 6m, J I 1 jQ� L" 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): cAd Z�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
21/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes EZ/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
7No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes y
❑ 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 �rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
Required Records_ & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
[%Yes ❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes rNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:_
1-4. Did the facility fail to calibrate waste application equipment as required by the permit? Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑YesrNo
o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes /No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [Zt/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes o ❑ 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 VN o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L!I o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations.(use'addidonal'pages as necessary).
17) )�CGP rjEj Ca C wi
� bg -rc t411
aq,) c30 oAJ
Reviewer/Inspector Name:
614� jA9fJ
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: �toutine
fiance Inspection O Operation Review O Structure Evaluation O Technical AssistanceReason for Visit: Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: S Arrival Time: Departure Time: 1 b C� -� County: P1 L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 197-u— k}��
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number: 1 Gy
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Design
Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Ca aR.
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part ofthe operation? ❑ Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes YN)
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page l of 3 21412011 Continued

Facility Number:
Date of Inspection: s
hq
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: UbGeD►�j 3 L.lA&<7o*s I �� 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): og 3 Ln
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoD
❑ 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
dNo
❑ 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 000No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F�<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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP [:1 Check] ists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes gNo
��❑ Yes
❑ Yes
❑ Yes g�No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E2rNo ❑ 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 ZO
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE

Facility Number: - Date of Ins ection: q11S11,4
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErMo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
[J'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�o
❑ 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
[2No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EI/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�lo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F3"No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �'j O,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: n `)
Date: y l 5 Iq
242

type or vlslt. W C mpuance inspection V uperanon Kev►ew V z!otrucrure Evatuanon V 1 ecnnicat Assistance I
Reason for Visit: Routine Q Complaint Q Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ► 3 Arrival Time: Departure Time: 9 5 � County: C)UP( Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: 2=C_ 000,2=5 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 12 419
Certification Number:
Longitude:
Design
Swine I Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
24CO
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
D . P,oultt. Ca aci_ JEW ,
Layers
Daia Heifer
Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Other
Other
Twke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ NA ❑ NE
[:]Yes ZP
❑ NA ❑ NE
Page l of 3 21412011 Continued

Facili Number: - Date of Ins ection: b k-3
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?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4
UAG-00 k L A Car.J L t-AG-CDA3
PS a9
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E2<o
❑ NA
❑ NE
maintenance or improvement?
Waste Aaolication
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 hIo ❑ 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 20 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes WNo ❑ 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 j'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes go
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: 2 J1k t3
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List 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 �o ❑ 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
❑ NA
❑ NE
and report mortality rates that were higher than normal?
7No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
laJ Na
❑ 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
[D(No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
6
34. Does the facility require a follow-up visit by the same agency? ❑Yes No ❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any -other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
b
Phone:
Date: l�
21412011

Type of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: je Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q; , Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: G.Jj_(�M 0aR_� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: �qq (1
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity 0Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
7$ap
Non -La er
I
Dairy Calf
Feedcr to Finish
Dairy Heifer
Design Dry Cow
D , P,Oult . Ca aci P,a , Non-Datry
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[] No
❑ NA
❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]Yes dNo ❑ NA ❑ NE
[:]Yes FNo [DNA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - 651 jDate of Inspection: q
Waste Collection & Treatment
4. Ins, 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
Stricture 1 Structure 2 Structure 3 Structure 4
Structure 5
Stricture 6
Identifier: L A6ztP 1
Spillway?:
Designed Freeboard (in):
�7
Observed Freeboard (in): 217 z I _
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
dNo ❑ 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 environmeintpl 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 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 [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 a No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
� Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have Certificate Coverage & Permit
the to the of readily available?
❑ Yes
[�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? I€ yes, check
❑ Yes
L'J 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 040 ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: Z Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C? N ❑ NA ❑ NE
25.4s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2fNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 ZNo
❑ Yes U No
❑ Yes dNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes fNo ❑ NA ❑ NE
❑ Yes 6N0 ❑ NA ❑ NE
❑ Yes 640 ❑ NA ❑ NE
Comments (refer to question #f): 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).
f! l WEcn C'ejr-r L' p6EIDEo fb0- Ate {'X t-05,
Reviewer/Inspector Name: %}OHO r VjX-(- _-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: CQI�
Date:
214120II

Division of Water Quality. "� x
Facility Netmber '�j ( I %3g O Division of Soil and Water Conservation'
tiO Other Agency
Type of Visit ()(Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (/Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: j D Departure Time: County: N Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o ❑ 1 0 Longitude: = ° ❑ 1 [� «
Design. Current Design Current `_
�Swme A Capacity;.Popula[ion WeiPoultry%. Capacity Populahori, Cattl
1 LJ Wean to Finish
1 IWean to Feeder 1 i'Kh(N I qb Ob
Farrow to Wean
Farrow to Feeder
Farrow to Finish
J Boars J J
ether. f:
] Other
JLJ Non Layer I I
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
n❑ 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?
Dairy Calf _
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
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
EI�No
❑ NA
❑ NE
❑ Yes LI No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection L '2rk
_ rite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LI No ❑INA ❑ 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: ��� N Z LA(�co�3
Spillway?:
Designed Freeboard (in):
'Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U 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 environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes QNo ❑ 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 E 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 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
� o
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
20
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WE! o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LI o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawtn. s of%g facility to'lietter ezplatn sttuahans (use additional pages as`necessary):
Reviewer/Inspector Name F 6tAR PhoneQq1@
Reviewer/Inspector Signature: Date: l 2A 1�
Page 2 of 3 12128104 Continued

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

r
'Jl
0
Type of Visit 6 2*Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 i ft7 Arrival Time: I iD 0 Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: 16,V 1 Integrator:
Certified Operator:
Sack -up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= o = d = Longitude: = ° = =
DesiIfficurrent
Design Current
Design Current
Swine pulation
Wet Pout Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
Wean to Feeder
dg5us
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
El Beef Stocker
ElGiltsGilts
El Non-LayNetsers
❑
❑ Turkeys
❑ Beef Feeder
❑Beef Brood Co
❑ Boars
Other
❑ Turkey Poults
❑ Other
mum of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[I No
El Yes
�/No
❑NA
❑NE
ElYes
❑ NA
❑ NE
12128104 Continued

631
Faclhty Number:3 Date of Inspection e D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:(.MCozD7d I r IBCMD� L 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z3 Z.3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes IQNo ❑ NA ❑ NE
❑ Yes [2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �/N
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ NA ❑ NE
❑ Yeso
(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 6/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IGI 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
QNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2(No ❑ NA
❑ NE
16.. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
,dNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
rN❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other commenis N.;
Use drawns;of faciitty, to be, P, (ges,asnecessary): tter_ex lainsttuahons. use- w
g additional pa
e ,.
/T.) G-C-r Tl-iEC uP0AT(
Cs 40[> Qe=R—rt_TT,
�
Reviewer/Inspector Name
o t l,�} � .:. Phone: 16
�b
Reviewer/Inspector Signature:
Date: 3
4 Ib
Page 2 of 3 - 12128104 Continued

if 631
Facility Number: 3 — Date of Inspection 3
>?%uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and P
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
E�No
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VTNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,_ONo
eNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1p No
❑ NA
❑ NE
Other Issues ,_ ,/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes [] No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��,, ff
[3 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O'NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
tz
AddionaFC©mments andJor`Drasvm
a
t
12128104

Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S of Arrival Time: ® Departure Time: I� County: III L=J Region:
Farm Name:
Owner Name:.
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: &_LL ocx-R_qts Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 c [=.
= Longitude: = ° 0' = «
Desigu Current
Design Current Design Current
Swine Capary Population Wet Poultry
Capaci3.
ty Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer
❑ DairyCow
Wean to Feeder ` 92)0 ❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
El Farrow to Finish ElN Layers
Gilts ❑on -La Non -Layers
PE]Boars El Pullets
❑ Turke s
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ N
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El YesVNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment ,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes !,Q 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: L,AiyMAJ ) L.A6:y. V Z _ LA6vopJ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a 3 137
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 El 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? ElYes d No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes �No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes V<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[3 lvo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Y s
15. Does land improvement?
No El NA ❑ NE
the receiving crop and/or application site need ICJ Yes
❑ o ❑ NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yesWUo
o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ o ❑ NA ❑ NE
l' } pteg Co+rRotr- A/EE_DF_0
Reviewer/Inspector Namej Phone: 1p
Reviewer/Inspector Signature: Date: 4
Page 2 of 3 12128104 Continued

+ Facility Number: ` —(p'� Date of Inspection
Required Records & Documents ' f
R Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 2(No ❑ NA ❑ NE
the appropirate box. ❑ ❑ ❑ ❑ ❑
WUP Checklists Design Maps Other
21 _
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
E7 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
� o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
L"J No
❑ NA
❑ NE
Other Issues
�o
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
dX o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,__/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
hd
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
H
Page 3 of 3 12128104

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
:::— - - - Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (, Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: arj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No: _
Onsite Representative: V)- � i LfirV1 062A?r.< Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E—] o E:] ' [_�] Longitude:
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder I -]$
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[__1 Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 Date of Inspection
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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&voA ) i LAGM60 'L- LA G"oaN 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7No
� ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 7es ❑ N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes bNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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 6 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�4o ❑ 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 Drif3 ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) i
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
El NA
El NE
VN
❑ NA
❑ NE
Lf'N0
❑ NA
❑ NE
ET'No
❑ NA
❑ NE
❑ 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):
G bN�E Wale-k- aN 9-001 T FR.oat_. M. AL
Sil►�V6 e f< CIV61L1A0 .1-Z.6ag X- GPI' T' DLIA .
a O to `� S
Reviewer/Inspector Name '-fa lj F1a,2.1,j Phone: 1910 71 b 'i3 Y d
Reviewer/Inspector Signature:
Date: 2/Z•� 1

F.achity Number: - Date of Inspection I �lZ idi 1
IRequired Records & Documents �f
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes la No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections, /O Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes [3 NN El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WN
o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? 011y'es ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes LJ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
VNo,
❑ 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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
do
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Yo
❑ NA
❑ NE
Comments and/or Drawings:
4
12128104

division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
- O Other Agency
Type of Visit
Co liance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 2-'y 4 Arrival Time: Departure Time: Q County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: i-M_t_.SAn\ Kbgxlj
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Latitude: 0
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
= « Longitude: = o = C = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
$oo �Q6v ❑Nan -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
ETDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El No
El Yes
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3k — Date of Inspection jIZI 3 I
Waste Collection & Treatment
It. Is storage capacity (structural plus storm storage plus heavy rainfall)'less than adequate?
❑ Yes
hTo ❑ NA ❑ NE
a. 1f 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 (elma [ LA G.0, f Z_ __1 AC,4D,) 3
Spillway?:
Designed Freeboard (in): _ ..0
Observed Freeboard (in): 3u
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
E KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
dyes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNo ❑ 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
PVo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 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
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,Ej`NNo
L" No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
❑'1Go
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
; "o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
' No
❑ NA
❑ NE
Comments (refer to question #): 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):
T) DLK, t uTO OZK(- wkLLS . L e-ATS - #LPus(L�ta) fJO-9 -?(Sr UAIRZoc. AL
Reviewer/Inspector Name `—Jo 14W rtA" 0L Ll _ Phone J110)_i96 --7 59
Reviewer/Inspector Signature:
Date:
12128104
a
Continued

aFacility Number: — G Date of Inspection
~ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes d> o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
p4o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
LEI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
��No
La No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,ONo
LJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IQ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L7 N
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
t5No
❑ 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 El"No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104

20
Facl�tyNumber
3
3
Qj Division of Water Quality
O Division of Soil and Water_ Conservation ✓;
O Other Agency
Type of Visit &7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 02 I ob Arrival Time: 8 :�f5 Departure Time: County: vP *J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: 0 0 = ' 0 Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer 7� ❑ Non -La er
❑ Wean to Finish
El Wean to Feeder
16
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
Dry Poultry
❑ La ers
ElNon-Layers
❑ Pullets
❑ Turkeys
❑ Turke Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
El Dairy Cow
[I Dairy Calf
El Dairy Heifer
❑ D Cow
ElNon-Dairy
El Beef Stockei
El Beef Feeder
❑ Beef Brood Cowl
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 CJ No ❑ NA ❑ NE
El Yes
El No ❑NA
El NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ElNA
[INE
❑ Yes
ElYes
No ❑ NA
❑ NE
❑ Yes lJ No ❑ NA ❑ NE
I2/28/04 Continued

Facility Number: 1 — Date of Inspection ; 0�
r.
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
A r Structure 1 Structure 2 tructure 3 Structure 4
Z WC 3
Structure 5 Structure 6
Identifier: !V 4 R>Zs JK t" n-W
Spillway?:
Designed Freeboard (in): 19 S. S 19 S
Observed Freeboard (in): 25' 2(o .1(0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes — No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2/No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Id 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 2No ❑ 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. Crop type(s) I3 6 amo 0.A .� G s (ylJ
13. Soil type(s) A V l3
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
❑ El NA El NE
CJN ❑NA ❑NE
I No ❑ NA ❑ NE
L/ `N9 ❑ NA ElNE
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): t
PAo o9 ok-M CxoP '? T eLt) Fc>(,�_ 14Aq NOfLTA LM"T `I' M-_CA"
rNTC_G�To-(L.
ReviewerAnspector Namey6 }�„ . 1 1,;f� Phone: !jl 74(r — aC:o5
Reviewer/Inspector Signature: �u� l•` Date: .24 1 0
X-"XC Z. Uf J IG/LO/U'f l.V7lllriur [

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

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:/ f /(Jfjl Arrival Time: %,` d Departure Time: f Q County:
Farm Name: /l/f�LL� o"7- e Owner Email:
Owner Name: 1�ill iL �,g a22 z Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: Integrator��5
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: E= o a' 0,1 Longitude: = ° [� / [� /1
i=19'
M Y
1
^•G�
;'. yl... Y,,. :�„^g'
4C2On
1a,@, ;yi'
-♦Y
■ 1' 1
��
y,.Y >E- !' irrg�¢ bs.s 40..fiyx
i.
■ �. '
El Farrow to •
z+. i .sa ...'-�'a' rah '
J r 1 1 1 � S`r9 �.�. ii•
+> i+". 3 #..
'� i K
■ 1 1
94.
.._. ...� .. .. '+, F� -
,-. :'.�- •Z; : x" �, �
Y��__:.A \= r..,'Vy!�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[Z 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
W No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;3 No
❑ 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
V 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: — At / fad & 3
Spillway?: IVD A)v
Designed Freeboard (in): 19,5 _lq 5 19.51
Observed Freeboard (in): 2`T .3 3 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
A 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
[f 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
9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[f 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
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/n1 ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) yC JFIQlJI aD4 c�tfi'Zl��� �-S. fir, (19a'645'C-4'_O�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
m No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
9No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /Z1 No
❑ NA
❑ NE
P�
15) 4��O &Ztj h is 111Iel-1) T ,94
Reviewer/Inspector Name 1 Phone:
Reviewer/Inspector Signature: Date: O
12/28/ 4 Continued

Facility Number: — Date of Inspection
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? VYes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [71 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P] No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
T No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LZ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
�z 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
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1Z No
❑ NA
❑ NE
Additional Comments and/or Drawings:
F FRO FA
�7�Y6StJL
_dOiAC941
12128104

JR(Permitted gCertified 13 Conditionally Certified 0 Registered Date Last
Farm Name: ............................ County
%
Owner Name: ..... LnIM IiM_ ................ram QA_9:........................................ , .5... Phone No:
.3 I Time: SO
Q Not Operational C Below Threshold
erated or Above
)Threshold: .........................
..
.................................................
Op
MailingAddress:................................................................................... .................. _. ..... ........_.... ............. ............. .............
Facilitv Contact: Title: .................................................. __.. Phone No:
Onsite Representative: ... L, Integrator:
Certified Operator:. _._...._._..__.. _ __- _._._ .. _._ _. ...... Operator Certification Number:
Location of Farm:
❑ Swine [3Poultry [3Cattle [3Horse Latitude Longitude
Discharees & Stream lmnacts
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 than -made? ❑ Yes ❑ No
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 gaurnin?
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? [3Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...........1.................................2..............................-..11�................................................ . ...... .......
Freeboard (inches): 3 O—L
12112103
ElYes [INo
❑ Yes ❑ No
❑ Yes XNo
❑ Yes PfNo
❑ Yes ANo
Structure 6
Continued

�5
Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes �No
❑ Yes Z2�No
❑ Yes gNo
❑ Yes )KNo
❑ Yes )KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes A'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 I-1ZM0SA ( 9) SMALL 6RuiZIJ 02ca-SEe0 _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes A"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 5
c) This facility is pended for a wettable acre determination? ❑ Yes �No
15. Does the receiving crop need improvement? ❑ Yes'0No
16. Is there a lack of adequate waste application equipment? ❑ Yes 9No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
19. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )�lNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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.
rComyitents {refer," gnestibm ) EiRplarn aay ,YES'answersilor any; recomaiendatio or a_ny other,iwmuments.`w�
eam
sUse drawings of pagesFinal
gField Cy_ Notes
s.ra
,s...stytobkry�)
4.� ... :t �.�oL'YY _ln
�a
N A? R6(2()MED fii11S1PQ r1,)A? b3t'46 .
a(, CoG AND -?CRrvtS_r WrECD To $F UR( os
�Aa,M _f V i L ftA A.Of1 COED .
7
Reviewer/Inspector Name
ReviewerAnspector Signature: Date: 3
12112103 Continued

�R
Facility Number: —
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
XYes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
'P(No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PINo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
RrNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ffNo
/
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
"/JNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
XNO
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit OCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit dRoutine Q Complaint 0 Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 1 Date of Visit:
Q Permitted 0 Certified 0 Con�d'itionally Certified 0 Registered
Farm Name: w-,1`ri�r7Vorr'i s FaY'rW%
Owner Name: , 1' �' 'iOrr-' !
Mailing Address:
Facility Contact: Title:
Onsite Representative: l"I ' l r +^1
Certified Operator:
Location of Farm:
Time:
Date Last Operated or Above Threshold:
County:
Phone No:
Phone No:
Integrator: grin �J D; Celfn l ' 6A
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' " Longitude '
Design Current
nwiae (,;apacitv ro matton
❑ Wean to Feeder
i
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
, Number`4Lagoons _ 3
Holding Ponds /-Solid Traps
Design Current Design Current
Poultry CapacitV Population Cattle Ca acity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other I' 4 }
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present ❑ La oon Area Spray Field Area
- _ — - - -
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment .
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: / Z 3
Freeboard (inches): 2 -3 _740
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J� No
❑ Yes ❑ No
❑ Yes �TNo
Structure ti
05103101 Continued

r
t,
r
Facility Number: ,3) — 3G} Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
It. Is there evidence of over application? ElExcessive Ponding ElPAN ElHydraulic Overload
12. Crop type -Be r m M,-% (v /� roLze , SiMG! 1' Gf'q ; n
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 2No
❑ Yes XNo
❑ Yes ONO
❑ Yes ONO
❑ Yes )zNo
❑ Yes ZNo
❑ Yes ,Z No
❑ Yes'ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes JdNo
❑ Yes VNo
[:]Yes ,�fNo
Ores ❑ No
❑ Yes JyNo
❑ Yes 2fNo
❑ Yes ONO
❑ Yes JErNo
❑ Yes "No
❑ Yes ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
t _ y. 4,
Comu�ents (refer to question #): Explain any YES answers and/oa• any recommendations or any :other comments.
e
Use di awrngs f factLty to,bettei explatn,situati4ns. (use additional „gages as necessary) El Field Cony El Final Notes
l4-t 117. Needls ct m-cf W'n;cL,, Go{resf6^,0(s 4,9 Ae we able otGre5 1
we.rkS�eG4S D�dl-►e �y-y-�eG�rniGn) s�PeG;[��iSl�. Mnsl,a+old% Gr��es�a�Ol
N��( ;Ile
fp eNdr ksh�}s, �p y7^ve 1 oe�F.0" A 1; e'al4e O^ ,
q s'7A arer-4e e)t e Go, -A - 17 Ar-.d reeo fd eveyl Lr GGGerd 3�jll
��. /1,�u30� �o i.-�.,p,.•vye be�-vA� ;n b� �'� s .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 31, tz'O-L
05103101 Continued

Facift Number: x Date of Inspection 3 PZ 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? ❑ YesXNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P'flo
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 ONo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings; =77.
-
.&i
J
5100

:Division of Water Quality
-
0 Division of Soil and Water Conservation.
w 0
_Other Agency .-.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 1A0outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: �� Time: iSZO Printed on: 7/21/2000
O Not Operational 0 Below Threshold
© Permitted [3 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name:.........County:
........ .... .......... tl ......................................................
OwnerName: .................I ....... !................n ....n rS.....................................I.................. Phone No: .......................................................... ............................
Facility Contact: .............................................................................. Title:................................................................ Phone No:
..................................................
MailingAddress: ............................I...................................................................................................................................................................._......... ..........................
Onsite Representative:... ? .�.(...p.¢r /%.'. f......................... Integrator: / Qi+� r.. ... .ps.!!'Z7 �...'./LDi...................
..........................
Certified Operator:................................................................................................................ Operator Certification Number:
Location "of Farm:
OSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • 4 49
- Design
Current Design Current Design 'Current
.,. .: city
Poultry cattle .
Population cCa Population
Wean to Feeder
.10Layer ❑Dairy
Feeder to Finish
❑ Non -Layer ❑Non -Dairy
Farrow to Wean
Farrow to Feeder
s
❑ Other
s= Farrow to Finish
Total Design Capacity
Gilts
_-
_ ;-' Boars
Total SSLW
. Nuathee of
10 Subsurface Drains Present Lagnnn Area 113 Spray Field Area
SoldiingPonds 1 Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: [3 Lagoon ❑ Spray Field El Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes XNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes JXNo
c. If discharge is observed. what is the estimated flow in gal/min'? h /
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 7No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,12rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes - PfNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..............r.................... 2- ........................3
........................................................................................................................................
Freeboard (inches): �^ 37 321
5100 Continued on back

Facility Number: 31 — 3 Date of Inspection I (�Jl 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 ffNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes L'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ja'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ,!fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2�No
11. Is there evidence of over application? ❑Excessivvee Ponding [I PAN [I Hydraulic Overload ❑ Yes �No
12. Crop type 16er Aghvefe 1,tin 2e . K'Ll a 1,' na ze
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes jallo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
No•* atigr;s:oi- defieienCtes •vt*re hoed- dirr'kng �hls:visit: - You Vfl1- eceiye iio: further
cories oridenke' about, this visit.:.
ARV
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes .,ONO
❑ Yes 0No
❑ Yes A No
❑ Yes X No
❑ Yes 11;'No
❑ Yes .,O No
❑ Yes ,2 'No
❑ Yes _7f No
❑ Yes , ff No
❑ YesXNo
❑ Yes;,rNo
f �� �ac,'1►'�7 G re fv l q vu( recarAf Aee w ell kc f f . 1v.,A -Fa ec.-.n ve nohbeewdt,
,,Tueje+cv4iat'1 QM Wow eS1c bls- , be► n vm in one arect, o��e let l-qrd
Srde 6e r*VVV t -lr; el f near 44e. 6ek I 0fl 60#11+er .
qV
Reviewer/Inspector Name
Reviewer/Inspector Signature:
7o necrv�
Date:
5100

Facility Number: - 3 Date of Inspection ( t3 Printed on: 7/21/2000
Odor Issues
25. 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 VNO
28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes JONo
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 O No
30, Were any major maintenance prohiems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ENO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

_ ivtsWEoUwiibek Quality
.�k
r 0 Division of Soil and Water Conservation ' + , _ ��z
r -LOtherAgency '� ,r
T t " - -'
Type of Visit Compliance Inspection O operation Review O Lagoon Evaluation
Reason for Visit )§ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: ` �r] Printed on: 7/21/2000
_�,
Q Not Operational 0 Below Threshold
#Permitted XCertified Q Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ....
Farm Name: 5 ` �...` ' 11 a jr1 ' �'r'� County:..... .` . . �. ...... .1... .................
.................... .............I.............................................................................
Owner Name: ! f 4 n..". - /�Q r {I. S
Facility- Contact:
Mailing Address:
Title:
Onsite Representative: ............V-,;ji.?. yam,,../
Certified Operator: ............. �
Location of Farm:
PhoneNo: ............................................................ . .........................
Phone No:
.................................
........................................................................................ ..........................
Integrator: ....... .3.... E-.h=i..
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current. Design Current Design Current
S e Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder 00 ❑ Layer 1 ❑ Dairy
❑ Feeder to Finish ICI Non -Layer I I El Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
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. ll dlschan.-c is observed, what is the estimated flow in gal/niin?
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
9A10
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
,fNo
Waste Collection & Treatment
C
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Str�iirc 3 Structure 4 Structure S
Structure
Identifier: .................. L.............. .. Z . .......................
Freeboard (inches): 30
37
5100
Continued on back

Facility Number: 3 Date of Inspection FF __Z_ Printed on.• 7/21/2000
. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) rr/
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes o
(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 maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XN 0
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
El Yes
XNo
12. Crop type !Z Ue- _ e 4 ) ef u
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
iAo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
X10
b) Does the facility need a wettable acre determination?
El Yes
(❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15- Does the receiving crop need improvement?
❑ Yes
KN0
16. Is there a lack of adequate waste application equipment?
❑ Yes
�N0
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
El Yes
rf!
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
t!(No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
P60
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
49,
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0: Rio gtis:or defeieticie5 were ...
during �his:visit; Y:oik will reeeiye do #'urther
corres}�ondenee: a�aut this• 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):
Parm 16dks Z7,p,0/ /
�ree_6_0sf 160/c 0001
I Reviewer/Inspector Name 1Z --5S L.�Ifb I/ I
Reviewer/Inspector Signature. l% ce `v' Date: I (—?_v--6Q 5/00

Facility Number: 3 --L"3g I Date of Licpeetion 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 q(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 j No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes d`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 F11NO
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? El Yes f�f N` o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ( No
Additiona]:Comments,an or rawingsc
w
5100

[� Division of Soil and:Water'Conxervahon -'Operation► Revrew
In
Division of Soil and: Water Conservation•- Comglianr a spection y _
'Division o€ Water Quality -� Compliance Inspection
OOther Agency',!-'Ope`ration-Revnew
Routine Q Com laint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:min)
© Permitted [] Certified [] Conditionally Certified p Registered 10 Not O erational Date Last Operated:
Farm Name:.......�.A...j..1.j................. n .. .......... -...................----. County:........
Owner Name: ................ Phone No:.........-...-..
............................................................................... .....
4li
�n3 �........... , Phone No:.... Q--5—
Facility Contact: ..... ��........L. G... ............................................ Title:..... ti ` "�' ` Q..... ll ............. ?i...... )
MailingAddress:.....................................................................................
Onsite Representative: v " ` �`�l S ...... .................. . Integrator:rJ........
..,....... ..... `" �T.......................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
.............. ;
Latitude Longitude • 0` Des
Design Current , - Design Current Design Current
--'`' Poult" .. �.. ..- ,,.
_Ca acity Population !T . Capacity °Popiilatiori Cattle; Capacity Ti'op»lahon
Wean to Feeder
0 0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
,Number of Lagoons ❑ Subsurface Drains Present 111771 Lagoon Area ❑ Spray Feld Area
HoldinjTonds / Solid Traps 0; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
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 disrharge 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 J;�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? . ❑ Spillway ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: rr-�� {{�...�
Freeboard (inches): .V............ ......... a'.....................�'......
...... ....... ................... I............... ........................ ..............................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3123/99 Continued on back

Faeliky Number: 3,A -A l.)atc cat' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 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?
$. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aeplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes
XNo
❑ Yes
�No
❑ Yes
No
❑ Yes
No
❑ Yes
9No
❑ Yes
W No
—
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Cl Yes 9No
❑ Yes 9No
❑ Yes KNo
❑ Yes M No
❑ Yes ONo
❑ Yes XNo
❑ Yes ANo
❑ Yes K No
❑ Yes K No
❑ Yes . XNo
❑ Yes P�No
❑ Yes 4 No
❑ Yes 4No
❑ Yes KNo
❑ Yes *o
N,tJ-vi61'aiioris:oir deficiencies •were n4rfed• dirritng #bis:visit. - °Yoi} Witt -receive iio fuirther
Corr .... lei' ce. ab' k this visk � . - � - .. _
Comiiiirents (referid question #): Explain°any YES answers and/or auy recommendations or.:any other comments.:
_ x
Use drawings of facility to better explain situations {use'addittonal pages as necessary) -
a
Reviewer/Inspector Name
Reviewer/Inspector Signature:
FIT �-UW_Offl
3/23/99

IF'ati ity Number: — k; I 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?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes i 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 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
ddition _ omments,an W
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
lqkRoutine O Complaint O Follow-up of DWQ inspection O_Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3`�
Time of Inspection `{U U 24 hr. (hh:mm)
D Registered Certified D Applied for Permit D Permitted 113 Not O erational Date Last Operated:
i
Farm Name:
W.....1�:- N<'.-�'1...... '''' county:............. .\L...:.....................
Owner Name...... i �1t°`�'' �U+n��s. r-.... .. Phone No: Q `U� ���-�...C.-..� 6 3 � j .w'.YU
......................... ..... .......--•--••.. 1
Facility Contact: Title: ................. Phone No:
Mailing Address: ... .&......'.�?��.... Q-Cc.........ae—' � �`� �` w-4
((�� ��, jr�� ............... ................. "" ...............
...........
.........
..........
................................................ ......
Onsite Representative:-•17, lk..1`�Cs✓ ±5 - � .. Integrator•.... J.. ... ... +-?'................................
Certified Operator:.................................................................................................... ..... Operator Certification Number :...............
I, t•on Fa
=__M'
...r-...... 4:'`ri....! .................. !:�: f.......... G...........................'~......Tom... ... 1B.A.A...��-� �.�...�, ...� ��...................................................-----.---.--. --................. ............. F
-
Latitude ' 04 0" Longitude • ' r— "
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder.
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part- of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system,(other than lagoons/holding ponds) require
mai ntenancelimpro vement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes V[No
❑ Yes ((No
❑ Yes VO No
❑ Yes0 No
KA
❑ Yes [W No
❑ Yes[ No
❑ Yes No
❑ Yes No
❑ Yes Ef No
❑ Yes t No

r' Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0No
Structures (Lagoons,Holdint=. Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ;9 No
Structure V Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................. ........................... . 3..........................................................................................
....... I...........................
Freeboard (ft): ..... R...1........................... .r.� .
10.
Is seepage observed from any of the structures?
❑ Yes
0 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes
0 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
V(No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
tgNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15,
P type .... ..............................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
CkNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
R1 No
18.
Does the receiving crop need improvement?
❑ Yes
PJ No
19.
Is there a lack of available waste application equipment?
❑ Yes
jB( No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
Cl Yes
allo
22.
Does record keeping need improvement?
❑ Yes
EfNo
For Certified or Permitted 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
RNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
,@ No
No.violations or deFiciencies.were noted'during this:visit.• You:will- receive•no•furitier,
:•corresp�ndei�ceat�:ou>��his`.visit:•:•.•.�.-.•�•. . .�...-_ . :-_�....'.•.•••. . . ,. .... .-
Reviewer/Inspector Name
Reviewer/Inspector Signature: G Date:

Date of Inspect ion rez/ R 7
Facility Number fr3
Time of tnspection 24 hr. (hh:mm)
13 Registered 0 Certified © Applied for Permit E3 Permitted jrL1 Not Opera Date Last Operated:
j�� yI
Farm Name l{N��1.7.1114&...........
A90.(r 5t...... rry. .... .. C:ounty:.......{��.!.r.............................................................
Owner Name: .... ...... 1L`'xq.�.am ........ [vQm... ........ I...... ..................... ...... .... Phone No: .La O z 4763.........................................
Facility Contact:.... ......... t ,4.Qt' X......-M. ... Title ........ (ilAklgr� ................................... Phone NO: .01.0)?.15-.1oo—.........
il7lailing Address:...... ..0 .....�JL... �0....._....}.......................'....................................... ....1.f�s�[lilldl........��............................................ -/-3-4 .�:.......
Onsite Representative:..-.-. i.��.i.g.try........ +V. i.S...... ...........I ...............:. tntegraticfr:........ ..............................
Certified Operatort...................................... ............................................................. Operator Certification Number:.......
Location of Farm:
.. ....... 1....... ....... ... WA1. t�.c.e:.....►.nr>n..r.. bx�..... ,K..12. ..:. j`vrn..... t'.......�n....�.R...f.i..31...........r.�+..T-A.
...............................................................................................................
Latitude • 4 " Longitude • 4 4�
Design Current
Design Current Design. Current...:.;
Swine Capacity Population
Poultry Capacity Population Cattle Capacity :Population
Wean to Feeder
10 Laver 10 Dairy
❑ Feeder to Finish
10 Nan -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity :(jp
❑ Gifts
❑ Boars
Total SSLW
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area -
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation'? [:]Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (if yes, notify, DWQ) ❑ Yes P No
c. If discharge is observed, what is the estimated flow in galhnin? JA
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes P No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes IQ No
5. Does. any part of the waste management system (other than la,00ns/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 (8 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes X No
7/25/97 Continued on back

Facility Number: 31 — (039
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (La oons,Iioldiny Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. ............ .�._..._........ _.......# ........._..._.. I., .......... $.3_...._....
Freeboard(fty................ U............. ..............L ... .......�v ......... ..... ..................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes V9 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
54 No
12. Do any of the structures need maintenance/improvement?
t@ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Yes
No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WIMP, or runoff entering, waters of the State, notify DWQ)
S. Crop type -6.yrVWk.............................................................................................................�Yhl�.il..fi�.fCAir�............................_......................_.........._.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
M No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
ji Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
]$Yes
[INo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
50 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
60 No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
8 No
No.violations or. deficiencies werenotedduring' this:visit.-.You.will recei've-no further
correspandence aEiout this:visit:•:
Cominents (refer to question #) =Explain any YES: answers andlor anv reeonunei
Use drawings of fatiltty #o: bettei explain situations. (use additional pages as necessary} h
S. �21cGX-40 UJ� S 1� vxkokr ro 3- A Vz_ w%6om S�r�nlCl�r moy {� v%Lcde� Or`
a A01 vSe r%'Seir G�Ze�}
IZ. Gwes�on aa-eas or #,1i r11��V/O uo r mlkl S 4 �a oan �k � . G" ib �.y� " e.v. I ►\r" No, � of
�t
13cov\ 5,01e art" SW6 6 P04, cta � G�rs Meeju), EU-C t�on &1% +tvee
_-Lo.�oon -tt- 3 sk A 1gom a level wo-+r4 w.
{X. Piz vw �� �t`t `C1 "3 u�s5�'`�u0�mGof �r� ,�� W fa7t^S{� v t f 0*11 L-& 00n aesir ,
r u L anal v �d � c sod ( s f S�taU�d {ne �Gh. Cer�►��ta t A cove s�vo�lra b�a'�125197
s
Reviewer/Inspector Name �Wrt 3
Reviewer/Inspector Signature: / ` Date: ]