310654_INSPECTIONS_20171231

NUH I N UAHULINA
Department of Environmental Qual

(Type of Visit: OrCompll� ce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O.Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O'•f Departure Time: 1 o County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: r'T__V
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: l0 S�5/
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
n to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
DairyCow
Design Current
Capacity Pop.
an to Feeder
1 t�
Non -La er
DairyCalf
Feeder to Finish
0 7 e
S 4
DairyHeifer
Farrow to Wean
D , P,oult ,
Layers
Design
Ca gci
C*urren#
P,o P.
I
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
11
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Turkeys
113eef Brood Cow
NJ
Other
Other I
Turkex Poults
Discharp_es and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
0 Yes No ❑ NA ❑ NE
❑ 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)
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 FONN, ❑ NA ❑ NE
Yes❑ NA [] NE
Yes❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'UN6— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Yes ❑ No NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes El"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 M<O ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes D40
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Mo
❑ 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 N
❑ 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 FTNo
❑ 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 N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes N4o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. es D-N—o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio;-'No,
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 Condnued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? es ❑ No ❑ NA ❑ NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'5ow �❑ 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 ffNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No r1 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? ❑ Yes N/o+ ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ea'No 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' e
Use drawings of facility to better, situations: additional paes.as necessary):
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑-1157— ❑ NA ❑ NE
[] Yes To❑ NA ❑ NE
❑ Yes Jo ❑ NA ❑ NE
S . C c� lit CD e17 OL+ jC��•,.-� l
wo CC4(1�1'C4A0^
p ,,, / I,,, �L r e c w--�s
Reviewer/Inspector Name: �L'x q Phone: { QE ` 7r
✓ � "✓"'C � '��i� { o
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

rjW
Type of Visit: Q) 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 0 Denied Access
Date of Visit: ! Arrival Time: ® Departure Time: 1 " S (j� County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: min M=;T0Ae_IL--' Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
11-ayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder -JAI-0 10 1
INon-Layer I
Design Current
Dairy Calf
Dairy Heifer
Dry Cow
Feeder to Finish 6yo 6
Farrow to Wean
Farrow to Feeder
D . P,ouIt . Ca aci_ P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 DW R)
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 WN
o
❑ Yes
❑ Yes
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
ti
Waste Collection & Treatment
eo. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 ,Strrucc^tuurre.'2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6-6
�p O
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 16 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ 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 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes M/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):
Z
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
El�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes V
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 UfNo
❑ 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 rNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
45. 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 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 andlor document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �No ❑ NA ❑ NE
[:)Yes O/No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes r] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�o�
❑NA ❑NVE
o ❑ NA ONE
o ❑ NA ❑ NE
(Comments (refer to question #): Explain any -YES answers and/or:any additional recommendations or any other comments
Use drawings of facility to better explain situations'(use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Date:
5

Type of Visit: Q Ziance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ` Arrival Time: Fj7 Departure Time: County:,Dr jpu.�) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Gcu-'>'Jt �-G-7r_W C—LL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: l b 5 S 1
Certification Number:
Longitude:
Design Current
Design
Current
I lllilI l1lll!esign Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
IDairy
Cow
Wean to Feeder
ZAD
Q
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Di, P,oultr.
Ca aci _
Po
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes jNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
Yes ❑ NA ❑ NE
LPage 1 of 3 21412015 Continued

Facility Number: Z- Date of Ins ection: r
Waste Collection & Treatment
4. Is"orage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier: Lksad L
Spillway?:
Designed Freeboard (in):
Structure 4 Structure 5 Structure 6
Observed Freeboard (in): �� SQ —^
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentl threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ 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 M/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 q/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rxo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes V>o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ 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 E]�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ 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

FaciUty Number: 74- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. IAhe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Na ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ��No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
rN
o❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
1,ML-S
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
u>6 1c. a�./ G-Ozid Sly APC
Phon&- (,(U/ 1 U b J
Date: 6/1ta
24/2615

Type of Visit: &goutine
fiance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: b r Arrival Time: 3l) DepartureTime: County: bA� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ` "Ln' Kajaf: i , Integrator:
Phone:
Certified Operator: Certification Number: L S S I
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent
Capacity Pop.
Wet P©ultry
ILayer
Design
Capacity
I
Current
Pop.
Cattle
Design Current
Capacity Pop.
Wean to Feeder
'i/d�
t7[�
Non -La er
Dr l;ouIt ,
Layers
Design
Ca aci t7y=P,o
Current
ai Calf
ffDairyCow
ai Heifer
Cow
Non-Da'try
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
i urkcy Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes L] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 6 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: -
Date of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure I .Sttructure 2?? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Y, (r00N (i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C2(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Eryes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FTNo ❑ 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 �To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q14o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ ' o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Re uired Records & Documents
<o
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
l ]41'o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes — N/o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ 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 ONo ❑ 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 No ❑ NA ❑ NE
❑ Yes d ❑ NA ❑ NE
❑ Yes dNo
❑ Yes No
❑ Yes
❑ Yes g,Noo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional oases as necessarv).
q) C LEAW AxaWiD bilcL- W W-S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0
Phone:jl(J f
Date:
2/4/20 l

Type of Visit: Q Zputine
liance Inspection V Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:SE Arrival Time: L I� Departure Time: ® County: U141i Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Bme Y iA--m..TC,-0 66L/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: 9-1
Certification Number:
Longitude:
Desigh Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder ?,O6
Non -La er
DairyCalf
DairyHeifer
Feeder to FinishE_=1
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul Ca aci l;o
Layers
Cow
Non -Dairy
Beef Stocker
H1
Gilts .
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[—]Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NA
yNoo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: LAka-6-d fv
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
O/No ❑ NA ❑ NE
[:]No ❑NA ❑NE
Structure 6
❑ Yes jNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm�to
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA D. NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 2(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes � 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?
I I. 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[,Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2(; o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
UNo
❑ 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 Z No ❑ NA D 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? ElYes 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

FaciliNumber: - Date of inspection: 15
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ es
No ❑ NA ❑ NE
1 th 25. Is e 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:
101*
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
dNo ❑ 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
2r 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 FNo
❑ NA
❑ Yes ❑ NA
❑ Yes ❑ NA
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). .
�Gro
Ciq L.G S IJ o Vag- We � .
V
sl-bow.S 11('I6
L��LK V\/T-I'i4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
so ck L-P ,j u- vE C'
❑ NE
❑ NE
❑ NE
Phone:3)0 —?3 ff
Date: L&
2/4120 1

(Type of Visit: ®CCpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Farm Name:
Arrival Time: ® Departure Time: ® County: 0tjj7C_-tk Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Faciiity Contact:
Title:
Onsite Representative: R 12 F M-r-r 04 C[-k- Integrator:
Certified Operator:
Phone:
Certification Number: (G S S
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder / 7.Cra / 2 6
Feeder to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle 95—a c i KI
Dairy Cow
Current
0Pop.
Non -La er
El
Calf
—Dairy
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design C►urrent
Ca aci P,o
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
[:]Yes VNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - le Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (f {,66,J jist7/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35 60
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 ENo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or7envyinmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? s ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes [2/No ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0o ❑ 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
❑
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ICJ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F3/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ 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
D<O
❑ 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 Inspectio;'-Noo/D
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?
❑
�70Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number:
Date of Inspection. V1 x✓
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. IS the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
/No," ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ 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 to ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
To NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
M No ❑ NA
❑ NE
❑ Yes
2rNo ❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No❑ NA ❑ NE
�To ❑ NA ❑ NE
Vo ❑ 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).
7) �►�F Wg1.L o((,oS cj_avzd/ 954P
Is',) _doj ( l✓CED c0,1TKdt dc/ F30-LA6 6 -- E?,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 10 -- r
Date: s'
2/4/ 011

Type of Visit: (D Compliance Inspection Q) Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ((Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i Arrival Time: Departure Time: fG Y , County: D06ALZ#Q Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: l7 AIJOV L14 ! CPS TES , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
La er
Cattle
Da Cow
Design Current
Capacity Pop.
Wean to Feeder 'Lab
S U
Non -La er
Da' Calf
Feeder to Finish p
Q
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P■ou_t _ . Ca achy Pio ,
Layers
Non -Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes EliNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 6/No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faci6 Number: - (j Date of inspection: i
Waste. Collection & Treatment
4. Is sirage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA G-aW LAkW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll Lj 6 o
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 envir nmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? s ❑ No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes �No ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes F
.,rNo❑ 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 CZ/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 5/No. NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EkN'lo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes fNo
/vo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes []INN ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes I ❑ 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 ElSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

\`
[Facility Number: jDateof Inspection: s-
24. Dill the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes d ❑ NA ❑ NE
25. Is Ae facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rwo ❑ 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes LJ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[JrNo
❑ 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
[3/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
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
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
om
`E�N�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments :
Use drawings of facility to better explain situations (use additional pages as necessary).
Sd ran, L Sm azL, G6t,o wTk NE E01
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: / 39
Date:
21412011

(7 Division of Water Quality _»
Facthty Number - O Division of Soil and Water ConserFahon
E
e
Type of Visit pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 7Routine O Complaint O Follow up O Referral O Emergency O Other [I
[IDenied Access
Date of Visit: Arrival Time: 9 Da Departure Time: County: IDOPLcW Region:
Farm Name: Owner Emiil:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title:
Onsite Representative: DAO s Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = 4 =, Longitude: ❑ ° = 1 = is
Design Current` :.. Design Current a� �mDesign Cn�rent"
Swine
Capacity .Population Wet Poultry=_ .Capacity Population Cattle ,: Capacity ;Population`'"
❑ Wean to Finish
Wean to Feeder
/Z44
57
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ker.
Other
-_Dry Poultry � "'
Non-L
Pullets
Poults
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
U Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — s Date of Inspection 1
'waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[21 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
environm
tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
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
2No ❑ NA ❑ NE
maintenance or improvement?
Waste ARPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No
❑ NA
❑ NE
❑ NE
7ElNA
L�J No
❑ NA
❑ NE
QN
❑NA
[I NE
El NA
El NE
Comments (refer to question'#):Explain any YES answers and/or any ree©mmendations.or.anyother comimnts
Use drawings of facility.to better explain situations. (use additional pages as..necessary):.,
`
Reviewer/Inspector Name KN Phone: �1'/Q 7 b b
Reviewer/Inspector Signature: Date: INJO
Page 2 of 3 1 12128104 Continued

FacilityNumber: — y Date of Inspection D
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /�40 ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ld No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo
o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [JA<o ❑ 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
Ld N
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
7No
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Ld No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit C,00 pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ,� Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: E4E
Arrival Time: Departure Time: County: �hUPL.) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: QAi) lAi\) C-A&T& Z- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e [::] ' = " Longitude: = ° 0 d =
14
Design.
Swine Capacity
Current , _ Design Current Design Current
Pop�latian Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
JEI Layer
❑Dai Cow
® Wean to Feeder
Non -Layer
❑Dai Calf
© Feeder to Finish
❑ Farrow to Wean
I/OD
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non-Dai
El La ers
❑ Beef Stocker
❑Non -La Non -Layers
El Pullets ❑Beef Feeder
❑ Beef Brood Co
❑ Farrow to Feeder
ElFarrow to Finish
El Gilts
❑ Boars
❑ Turkeys
10 Turkey Poults
❑ Other
Othe
❑ 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E No�❑
NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of inspection 7i o
l
l
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: L (5*oa> i ! A6 Dw/ L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `i �♦
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 2No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dt,qo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PI 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 L✓J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O Wo ❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,L�J,/No
L3J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Frments (refer to question #) Egplam anyYES ansr,ers and
111.111.
Reviewer/Inspector Name IJ— Phone
Reviewer/Inspector Signature: Date:
Paron 7 'of 3 12128104 L Continued

Facility Number: 3 — Date of Inspection 6
Required Records & Documents
16. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes FiNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RfNo ❑ 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 EYNo ❑ 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
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[✓7No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�,�
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�J'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ENo
❑ 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
El Yes
�,�
b No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,,!!
[2' o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0140
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

3
- lType of Visit C mpliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: (i 0 Arrival Time: 9pD Departure Time: County: DVtIlh! Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: IAle-L A.S E L-
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = i 014 Longitude: = ° = ' =
Resignmlurrent
Design
ulation
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Layer
❑ DairyCow
❑ Non -Layer
El Dairy Calf
El Dairy Heifer
Dry Poultry
El Dry Cow
ElNon-Dairy
❑ Layers
El Beef Stocker
❑Non -La Non -Layers
El Beef Feeder
El Pullets
El Beef Brood Co
❑ Turke s
Other
❑ Other
❑Tur ke Pouets
❑Other
Number of Structures:
❑ Wean to Finish
® Wean to Feeder
�
[A Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
Discharees &Stream Imuacts
1. Is any discharge observed from any part of the operation?
El Yes
Info
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field [I Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El 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
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
I2/28/04
Continued

Facility Number: — Date of Inspection S Q8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesW—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: CAW w) I Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2/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 B 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 environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L/J N ElNA ❑ 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 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
0-'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
W
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is lack
❑ Yes
rD40
❑ NA
El NE
there a of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
A) rA)Z.. vM 9 01c
e A AP ( 91a 3P " L°'°
Reviewer/Inspector Name cJoHN Phone: fit
01
ll
Reviewer/]nspector Signature: Date: j Ohs
Pape 2 of 3 12128104 Continued

1.
u
Facility Number: — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
EZ/No
ElNA
[INE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
Z/No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design g p ❑Other
/No
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
N
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes7No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
❑
oo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ef 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
O/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional-Com`mentsaudlor"�Drawmgs:.' _ .. -w ... ;�. _,•;. ,'�
Page 3 of 3 12128104

Division of Water Quality
Facility Number �s Q Division of Soil and Water Conservation
- Q Other Agency
Type of Visit Co Hance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: tjQ Departure Time: County. 1 ZPL-10 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ` �y- Title:
Onsite Representative: ,DAJ LAK)(�S f 4J-
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: = o = 6 0 L/ Longitude: ❑ ° = ` = `i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
® Wean to Feeder
® Feeder to Finish
Lt C"
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Turke Poults
FDE-11
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 Populations
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F-1
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 6 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes I�i;ZE-1
❑ NA El NE
El 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 ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): F, S�
Observed Freeboard (in): 40
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes IJ No ❑ 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 [? o ❑ 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 ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2(No ❑ NA ❑ NE
maintenance/improvement? ,--,/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes L No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E; o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El -yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Q-fio
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
►rJ 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):
Iq CRASS CvTr Lm& oe-c6Eo Auo SOr►N,E SQaTf rfC4�p C "-ASS C6vCt ,
-ro rAk XV CaP ��' Laa-7 CQC
Reviewer/Inspector Name 561j 47j j -Phone:(91o) 796 - 7 3
Reviewer/Inspector Signature: Date:

• Facility Number: 31— (,,r Date of Inspection
4.
heguired 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 l4 No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ETN.
❑ 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 El
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El"NNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ff NN
ElNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
LJ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
RYes
❑ 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
ElLT
_.,�
No ❑ NA
❑ NE
29. 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?
ElE 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)
_f
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
LI No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�2No ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit OC...,,omm�piiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 04 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0LOLIMO Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ,�iQ PJ L1IST6fl--
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e 0 d = !i Longitude: = ° = 6 =
gi
Design Current
Design
Current
Design
Current
Swine C►apacity Population Wet Poultry
Capacity
Population
Cattle Capacity
Population
❑ Wean to Finish 1 ❑ Layer
1
❑ Dairy Cow
m Wean to Feeder a I 4IMP e7
❑ Non -Layer
Dairy Calf
Feeder to Finish J
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑Beef Feeder
❑ Boars El Pullets
❑ Beef Brood Comi
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 2<10 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'Co❑
NA
❑ NE
❑ Yes 2 N"o ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection v�
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:l4&v1t� Lja-GooIJ Z
Spillway?:
Designed Freeboard (in): / 1r. S _ s • S
Observed Freeboard (in):. AJe
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LI No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 hT El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 El,
Yes �'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ElNA ❑ NE
maintenance/improvement?
It. 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) 1K A SC O
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2rNo ❑ NA ❑ NE
2<0 ❑ NA ❑ NE
O'No ❑ NA ❑ NE
2<o ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Comments (refer to question ft 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):
1W
Reviewer/Inspector Name -7;� N _ Phone: �!1 �1t% 73
Reviewer/Inspector Signature: Date:
Page 2 of 3 112128104 Continued

Facility Number: 31 —jail 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 El Checklists ❑Design El Maps El Other
❑ Yes
o
ElNA
❑ NE
ElYes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ No
❑�N' A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
EI N
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ElNo
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2 No
NA
I--]NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
—❑
Ek//A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes FJ No ❑ NA ❑ NE
❑ Yes Id No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes U40o ❑ NA ❑ NE
❑ Yes QX'o ❑ NA ❑ NE
[Additional Comments and/or Drawings: 1 .1
Page 3 of 3 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: /2 Q Arriv 1 Time: 0' Departure Time: /z i unty:
Farm Name: -�� Owner Email:
I �
Owner Name: t S �p2Z �` J ��''�`Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1i411��AS%�L
Certified Operator: �Zf� r//J __
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: __LL/�SB�GZO
Operator Certification Number:
Back-up Certification Number:
Region: AI",
Latitude: =] o =]' = « Longitude: = ° = 4 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
00 o d { ❑ Non -La et
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
Dam
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - - - - - -- - --
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
❑ Turke s
❑ TurkeyPoults
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
El Dairy Heifei
El Dry Cow
ElNon-Dairy
El Beef Stocket
El Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: W,
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
x No
❑ NA
❑ NE
❑ Yes
;0 No
❑ NA
❑ NE
12128104
Continued

.f
Facility Number: — Date of Inspection
Waste Collection & Treatment J T
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: 0 v f
Designed Freeboard (in): 147- 5
Observed Freeboard (in): 31915' 60
ezt
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes d 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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 10
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DDrifi Application Outside of Area
12. Crop type(s) �. Cr t�11f1�'
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 acre determination%❑ Yes XNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes A No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes / No ❑ NA ❑ NE
� Ar e5 �` �, y'.K
Comments`(referto questron'#) Exilam aoy YESansv�ers and/aranyrecommendatiions or any other comments.
s „3 "_
Ilse drawmgssofifactlttyta better,eapiatnnsituahons(useoaddit<onaltpages+necessary):
L,9cdd.� ZEVZZ5 �am��El�� AFV&5' iWEZC_
�cG' �z7f/ L�N��'®U9-?.�✓ Lft�ao� i�(1e �S � .�' ., saw GrJ w �tl�
Reviewer/Inspector Name Z$ - Phone: [�f/�] q91— 7,
Reviewer/Inspector Signature: Date:
1212 810 4 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropirate box. ElWUP ElChecklists ❑ Design ❑ Maps ElOther 10
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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ 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)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
T �e:_Cw J 4cfS IV-aeD o OW�p . �,q� ✓p !�'! �iSQ Cr
Rlzcm
D I '-��2NG SSc(�5 ITF_� G d� Tf
y4
90 Fz �id 1 /// i5A_5,.
Z""� (�'0'0. 4.e2e�'
12128104

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J6 Routine O Complaint O Follow up O Emergency Notfiicabon O Other ❑ Denied Access
Facility ?dumber Date of visit: Time•
Not Operational 0 Below Threshold
0 Permitted 0 Certified [3 �� 3 C�,onditionaDy Certified 0 Registered Date Last Operatedr Above Threshold:
Farm Name: � �SL1Q !' !-- .�_ . _.�_ _county: 1[/�l�L�i►1 _ ...
Owner Name:
Mailing Address:
Facility Contact:---
Onsite Representative:
Certified Operator:
Location of Farm:
ie No: _ .. .
__. Phone No:
Integrator. �d pm t7___,_,__„,„ „_
Operator Certification Number:
w
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude • 4 "
Curren# i)�Segn current _ = DeQga Current
Svvrne �Po ' tton - aPouitFy` _ pa .-.Cattle -lam tton
can to Feeder
Q
[p00
Feeder to Finish
ZOD
DO
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
�`::�♦I1hi
Layer Dairy
❑ Non -Layer Non -Dairy
7.7
'ZiOther
-� r rr -Tonal '-Capaaty-
Djwharees & 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 galimin?
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
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
12 I2103
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,fNo
❑ Yes XNo
❑ YesZNo
Structure 5
Cowed

FaciIit Number: -- j Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes XNo
G10SLtre 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/unprovement? leryes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancehmprovement? ❑ Yes gNo
9. Do any stuctines lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes PfNo
elevation markings?
Waste Aanlication
10. Are there any buffers that need maintenanceltmprovement? ❑ Yes ZNo
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes XNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or y' c
12. Crop type
13. Do the receiving crops differ with those/designated in the 64ed Animal Waste Management Plan (CAWMP)? ❑ Yes 7NO
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes XNo
❑ Yes VNo
❑ Yes 0No
❑ Yes VNo
❑ Yes XNo
Field Cow ❑ Final Notes
€EQ 5 �4n1 E �AP�GyZN�S h`N0 fL VEC-�r�i 7' 4/� i7G O�G ;�,¢C K 5W
�rG r�DiJ ��. eoaz'o AIP r Qo i�,v
C t✓� �r1�4 6 � S�C�TED
L.
/`�/� � C/�
0 .�
�F-C� � � z i �o � ���pyi✓� �✓�YS �so
PaA;�r_' W/1 r/ / r
Ranxo,E0 / �qm 47 F/0 y(
Reviewer/Inspector Name _
Reviewer/Inspector Signature:
C
12R2/03 Cowed

Facilry Number: Date of Inspection a*dB
Required Records & Documents
21 _ Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;dNo
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
o
V']
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ YesYNO
❑ Waste Application ❑ Freeboard❑ Waste Analysis [ISoil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
[I Yes
2(p
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
1p
No
29. Were any additional t oblems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
NPDES Permitted Facilities
30. is the facility covered under a NPDES Permit? (if no, skip questions 31-35)
❑ Yes
J!fNo
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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
z
yy1_in�'
/5'tJ % a ✓�/�� 3•
12112M3

r
V.
d
Type of Visit )D Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not O erational Below Threshold
yj Permitted U Cerhfi 0 Conditionally Certified 0 Registered Date Last Operate or Above Threshold: _
Farm Name: t�L ` 7►" County: Z
hone No:
Owner Name: J✓+!✓y ��-"
d<�_
Mailing Address:
Facility Contact: Title! Phone No:
Onsite Representative: i Z<CN Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
V(5wine ❑ Poultry ❑ Cattle ❑ Norse Latitude 0' 06 " Longitude 0' 04
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Discbargss & 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?
N
❑ Yes /NO
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ff No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes /;�'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;dNo
Smicture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: USI 4W16 2 _
Freeboard (inches):
05103101 Continued

Facility Number: `fj - Date of Inspection tYL
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7- Do any of the structures need maintenancelunprovement? 0 Yes No
8. Does any part of the waste management system other than waste structures require maintsnanceimmprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes No
_Waste Application
10- Are there any buffers that need maintenance/improvement? 0 Yes � o
11. Is there evidence of over application? ❑Excessive Pon ' ❑PAN ❑ Hydrau%li�c Ov�eyrl,oad / e Y s No
12- Crop type Aaf n /&)% f lT� �J 1
I3. Do the receiving crops differ with those designated in the Certified/Animal Waste Management Plan (CAWMP)?
❑ Yes./Zl No
14. a) Does the facility lack adequate acreage for land application?
Cj Yes
X No
b) Does the facility need awettable acre determination?
[EllYes
No
c) This facility is pended for a wettable acre determination?
El Yes
�No
15. Does the receiving crop need improvement?]
Yes
No
16. Is there a lack of adequate waste application equipment?
Yes
No
Required Records & Documents
Fail Certificate Coverage & General Permit Permit
17. to have of or other readily available?
❑ Yes
ZfNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
C1 Yes
[ No
19. Does record keeping need improvement? Cie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ YesNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
8No
21. Did the facility fail.to have a actively certified operator in charge?
❑ Yes
VfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
Yes
No
/,ZNo
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
24. Does facility require a follow-up visit by same agency?
Yes
1�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
Cj Yes
j No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about .this -visit
r:,,{i2,`. k �L \ - -. - - 2 +n ��- � --.- � h \ h. - - - - �hv: V• 3 R: C tit i�.CZ' zz �; CC 2ki`�
eefer es lac iaa#lrja; : e3et'ea.
ie F ?>}}>...... ]d Copy Final Notes
u
:.i.....: .,.,.::..:.u•:...... ...... ... ........a .:-v:...........,-.-...::..... .:.,�.:v. ..: ....:-..-�-::....--...-.:.:.:::v t,::tv..:-:{. £K£iz - ..N.^'m^:C"'^-S:CUi:t ^'-<C.C_"J-.iLH �:?iML...-..-
A) FX-r PAO-4Z A0 R—CO /nM, r5.
�F
�.
:':{: -
.i :
Reviewer/Inspectorie'q Name x
Reviewer/Inspector Signature:ZZAQL9�LDate:

Facility Number:] Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [� o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes / No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ElYes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additlonal`Commentslandlor Drawings:
��✓ �GZ� ,g L� ��� y �F} Tip
��GrO /n m e-li
05103101

Type of Visit P.Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 3 Lr Date or visit: 35r 0 / Time-
Q Not Operational Q Below Threshold
[Xermitted [3 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ................_......
Farm Name:.......1/..V....��...�..........N....t +'ttn &........ I ................................................... County:..........."''"�1� ................ I......_...�.............
.................... ..................
3; ex'f
Owner Name:....... 6.4............................ ........ ............ Phone No: ...
......................I.........
Facility Contact: ...... sab ........ .. ..............................Title:............. Phone No ....................................................
MailingAddress:.... ..................................... ............................................. ......
Onsite Representative: 1-�e^......... Integrator:.,,.....ly! . �QY.t.�..}'.....�.t'.�
_ U
Certified Operator:................................................................................................................ Operator Certificafio Number:.........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �= ��� Longitude �• �C�.
Design Current
Design Current Design Current
Swine
Cap acity Po ulation
Pou�try _
-Ca acity Po elation Cattle Ca acity Po elation
Feeder
jj
❑ Layer
' ❑ Dairy
Finish
p
❑ Non -Layer
❑ Non -Dairy
Wean
FOF=owtoFeeder
Other
rrowo Finish
Ttitai DesiLirh Capacity
❑ Gilts
❑ Boars
Total Ss.
✓.� - - ^-a "". 'k. 'r :lam .
Number of LYagooiis❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds / Sohd Traps . y.1 ❑ 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. Docs discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
'N4
❑ Yes ❑ No
❑ Yes MNO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes YNo
01/01/01 Continued

Facility Number: — Date of Inspection a-
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes fl.No
Sture 1 Struc re 2 Structure 3 Structure 4 Structure 5 Structure 6
IdenIdentifier:.........1truc........ ........... :.......................... - ........
Freeboard (inches):............'- P.................. G. ......I.......................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ;(No
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? IdYes ❑ 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 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes K No
11. Is there eviden of�gver ap lication? ❑ Excessive Ponding [I PAN [I Hydraulic Overload ❑ Yes �o
12. Crop type 3 s
13. Do the receiving crops differ withthose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? El Yes o
15. Does the receiving crop need improvement? ❑ Yes K_�'o
16. Is there a lack of adequate waste application equipment? ❑ Yes kNo
14
e
Reauired Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
k(No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
I No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes4"No
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
_P'No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
XNo
01/01/01
Continued

Facility Number: _ G Date of Inspection 1 ) Printed on: 1/4/2001
30.1I diaee any evidence of wind drift during land application? (t.e. residue on neighboring vegetation, asphalt, []Yes 6No
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes MNo
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ZNo
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9&0
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes PrNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
�,la Pam: ,�. 5,� . vvas
iV"
%Z God wo
yew, odt GA`�M43
Reviewer/Inspector Name §A'
Reviewer/Inspector Signature:
,`wee. � w VI-U
Date:
01/01/01

'3rvrs�o'n of Water Quality
0
Drvrsion of Soil andIM' r Conservation'
c _ -
- a g D Older Agency.
lhiA4'_ --- - -
Type of Visit @[Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other
Facility Number V, Date orvisit: [
kPermitted [3 C�errt red 0 Conditionally Certified E] Registered
V v 11 EK
JFarm Name: ........ ..........I.........._.._.._........j;N...�-:".........................................
Owner Name:.......`.. h,/-
Facility Contact:.. Title:.........................
Mailing Address: ..............
.....
Onsite Representative: ••,-- '� , • . 't/ ��
Certified Operator:.. .........................................
Location of Farm:
❑ Denied Access
1:4filne: �� Printed on: 7/21/2000
of Operational O Below Threshold
Date Last Operat Above Threshold.. ........................
County:
Phone No:
Phone No:
.......... ................ ....... .......................L....................... ..........................
Integrator:....-.--.. �ll .T.�. -4 11'....
Operator Certification Number:. .........................................
'Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' i Longitude ' 4 44
Design Current
Design Current Design Current
Swine
Capacity Population
Poultry
Capacity Population Cattle Capacity Population
Wean to Feeder
JE1 Layer
❑ Dairy
Weeder to Finish
Id ov
❑ Non-Layer-4-
I
ILI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JE1 Other
❑ Farrow to Finish
Total Design Capacity
❑Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-Mn Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste vlanagement System
Discharees & 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 roan -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 cstimaled flow in gal/min`?
d. Dees discharge bypass a lagoon systern? (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
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yeses\10
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IJo
Structure I Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier: ............... :................. ... ...................................... .............. ...................... ....... .......
Freeboard (inches):
5100 Continued on back

Facility Number — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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? XjYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes _<No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes KNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes KNo
14. a) Does the facility lack adequate acreage. for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes zo
o
16. Is there a lack of adequate waste application equipment? ElYes
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?
s -
(ie/ WUP, checklists, design, maps, etc.)
El Yes
o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
1VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
C�No
23.
Did ReviewerMspector fail to discuss review/inspection with on -site representative?
❑ Yes
K 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
ONO
yib atigris:or di ftit this:visit. Moir Vil receive Rio further
corre*iri �eince. about_ 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):
1 S'irri- '; y45� �� ok"it-J, ,lam �a��i'i_ l 11 La,, t s .
Y Le a'V% ot,,r ." c...., , l �-�.�,,t _ 4 0,►.,, � � +� o v It S cJ v>, �3 r►-v+�u di
oz> 1 L _v pp ku'U
Reviewer/inspector Name C C. l
Reviewer/inspector Signature: r� �
Date:
5100

Facility Vumbe"r: Date of Inspection Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to disclarge Wor blelow ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Ir
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 MWO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or \,
or broken fan blade(s), inoperable shutters, etc-) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? A —Yes ❑ No
Additional - omments'an or; Drawtngs:
-14N
if pVY
0
M1
5100

=- 0 Division of Soi! and' Vater-Consei vation -:Operation Review
_ D Division of Soil and Water Conservation Compliance Inspection - -
�VISiQn of Water Qualaty -Compliance InspectAan
_ .E3Other Agency - Operation Review
12 Routine O Complaint Q Follow-up of DWQ inspection 0-Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection /_0 24 hr. (hh:min)
Orermitted Pcertified 13 Conditionally Certified 0 Registered [3 Not O erational Date Last Operated:
Farm Name: �j.f4/Ii7R.( ...-.... tr#.Y19r1.............. County: -..... l��l.-..-...............--.--..........."`.....-:..........
...................................................
Owner Name:.... lk:c...........�P/..t.)Vti....... Gal( ......... ................... Phone No:
...t�)........... 5... G3.......................----.----........
..JJ
Facility Contact: ..D
M......... �4i!( S r................. Title:...........11%. . G Phone No:
Mailing Address:..... .rJQ.....4�Xesol.,5,o,.�........Ytd1.Lr...........2.r...... .......... YCI�i....... �'r.... .Sid............ ...,e 8�� .d..
Onsite Representative:.......$.✓i.................
.✓....................................... Integrator:.........sL}...........................................................
Certified Operator:,.,,,,,,., �.� 1....................I., ... Operator Certification Number:
Location of Farm:
:J�
Latitude ���4 •9 Longitude • �6 4°
Design Current -`: Desi�._ Current DesignCurrent;
--�-._-
Capacity- - -
. Capacity y PopulationSwiner Capacity ty Population ---Poultry Po elation... Cattle
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of:Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding:Ponds /;Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes M1No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes �No
c. If discharge is observed, what is the estimated flow in gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Y s QNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..... U............. ` ............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1�"No
seepage, etc.) //
3/23/99 Continued on back

Facility Number: 3 l - bi5 Date of Inspection
6. Are there structures on-site'which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
Z7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ,
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? []Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(le/ 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?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Io'*RA'ati¢ris or- deficiencies -W► re hbfed d(WiAii 4bis;visit.' - Yoir will-teceiye do wither ;
::corresponden.is visit. . . . . . ..
❑ Yes 9 No
` ((Yes ❑ No
YL
XYes ❑ No
❑ Yes No
❑ Yes *o
❑ Yes g No
❑ Yes K No
❑ Yes KNo
❑ Yes KNo
❑ Yes T
q.
❑ Yes No
❑ Yes No
❑ Yes gNo
A -Yes ❑ No
OYes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes X No
Co uments.(refer fo questi6h ##): lazplatn"any YES answers„and/cir:any recommendations orany oilier coiuments
Use;drawings of facility to hotter ezplain.situations ;(use additional-pages,as necessary)
✓M S �C� -�Ylly� Sirttirt!tiiG►�S '6rD4-V e_e b 15rC� F `rker are- nD !will "'d
t qk .. 4-4-5 -�'it ,t _ �LWty lr p� ltnu iS rocs D�Ow� . Nils l° s Lr
,,,�,� tc;As pe�t� SH nm�f �qa t�U art.l�rvcal�s have W e� X re-64Z?C_LL_PL- SrKP--
J
�rliil rta..(- be r�.�S-��fr.-:� k�-�;� -Marv►1�-{-rCk-ar�(�tou.s�cs� � �`tV`� arc��� nq dot
r St��'
9-� cof^ re. ifArr -o e 7&-A t .
Reviewer/InspectorName G -' f`2 -1'
Reviewer/Inspector Signature: Date:
1 3/23199
�� �C�,e� �s esZ �S l�r• ,,,�� %ao.�s�+hQ Kks �� ! gIv'3�5 =39aa> �y f ZZS

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Cl YesN0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes jgNo
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 'CNo
30. Were any.major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes/No'
32. Do the flush tanks lack a submerged fill pipe or a pennanent/teniporary cover? ❑ Yes Aj No
3/23/99
5
:I
�. !..x.. �..rr r.e -rn ..-.-�.--., �-r... _... ...-- ..--::Y•'ri'":^sq'r-:-9n�.+rrq-;»-;-?Y:�•. ..+-�"'•i'.': .. �_._. ..__ _ ... _.. .. � -

�,� - [� Division of Soil and Water Conservation ❑ Otlter Agency R ��- ��,
Routine O Com laint O Follow-u of DW ins ection O Follow-up of DSWC review O Other
Date of Inspection S
Facility Number Time of Inspection © 24 hr. (hh:mm)
Q Registered MCertified 0 Applied for Permit 13 Permitted 10 Not qTerational Date Last Opera
:............
� `
Farm Name: ........._ J.l..."� ... .....8 .1 . ....................................... County:. .......... i..�
Owner Name. t `.`.�.L-. 51!1-........................................................ Phone No:
Facility Contact: ........................................ ............ Title:................ .... Phone No:
Mailing Address: ...q3.....1.6......'!-:`C-....1.1.�`'`F..l�.l....�\w��..........�`� �rl��......... ��U`
Onsite Representative:!-. e.. Integrator: ..... ....
Certified Operator .......... ... Operator Certification Number.... ..........
Lofatiffl of Fr
.... ............ .............:......�--3 ..... ��.,........�....:�...............................:...................... ' = ! �..............:............... J.............. �
_r)...J►a—t ... ................................. --------
Latitude I *1 41 49 Longitude 1 • 1 6 1 11
�rargn �,urre�u
Swine Capacity Population Poultry
Population.
❑ Wean to Feeder
❑ Layer
Feeder to Finish
3 b
�
❑ Non -Layer
❑ Farrow to Wean
Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total De5I
7
❑ Gilts
❑ Boars
Dairy
Nan-1
,n Capacity
otal SSLW
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
Wo
2. Is any discharge observed from any part of the operation?
❑ Yes
q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
O No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
10 No
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Wo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
KNo
4. Were there any adverse impacts to the waters, of the State other than from a discharge?
❑ Yes
&No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
XYes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C%No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[(No
7/25/97

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes CKNo
Structures (LaQoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IX(No
Structure 1 SKucture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �^ :t�..... .................................... ...................................................................... ...................................
Freeboard(ft)' .►............. ................................... ............ ............. .......... .................................... ...... ;............................
10. Is seepage observed from any of the structures? ❑ YesO(No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 0 No
12. Do any of the structures need maintenancelimprovement? E(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 WNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes 4No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
IS. Crop" ... ............. ......................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
IT Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes Nt No
1 ❑ Yes M No
13-No.violatioins•or. derkiencies:werenotedduring this:visit.- You:Will iecei�e`Ro•furiher :-
correspi)Odepce dhow ; , _ : ` , . ' : - . , - :
❑ Yes JoNo
Oyes ❑ No
❑ Yes (U No
❑ Yes gNo
W\Yes hkNo
❑ Yes )4 No
❑ Yes No
❑ Yes No
rah SAL
5 s
tom- • !�� �'� ��s a�(d. Sc.;�.�e� S°� 7/2sl97 _
c
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Date of Inspection1 '7
Facility `umber i
Time of InspLetion Ff-5-5­1 24 hr. (hh:mm)
© Registered M Certified © Applied for Permit 0 Permitted 113 Not Opera Date Last Operated: ......................
IV
Farm Name: ... 'S.�.K1l.mt]I.S.......�Cv-............. FkrYn�................................ County: ..... f.).LiJ.1..............................................................
OwWL
Owner Name: v►` ..........................
FacilityContact: c_ !
.............�l.Y.l........71k?1IY1ax3S....... ............ Title: ....... a.fpst.�.t,r............................ •
' ...... Phone No•
.... .... ........
Mailing Address:.... .I9Ll...... ��.�r....k�.ti!!iV.....a....... N.octt...................................LL >< ram...t. N.lr_.._..................................
Ousite Representative:.. P!.T.F.A').... X rMx1RFtS.................................................... Integrator:........1.h.#.Ita{I1J.6!. .........................................
` 1 a 1..no......
Certified Operator:............................................................................................................... Operator Certification Number:....................
Location of Farm.
a1.. ....:........`?Q3...i�ar.. ►ra........ n.�ka�ft.... ............... Y.. �e4.r......(e.:. ....�lx►. i..... ...11.1.. a ±.
?�1! ... _...91.......�J ...{ ..:... JrC .....0 ..........:. ....kYAt. ._..D..+3... aS ..... ]..:.................... .......... . P.,
Latitude Longitude
.Design � ,Current_
' -Capacity Population., Poultr
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
Z46
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Non -Layer
❑ Other
ent r ,Design �,Cui
it
i6d Cattle` Capacity,..vi'op
❑ Dairy
❑ Non -Dairy
Total Design;Capacity,,
Total SSLW
Number of Lagoons/ Holding Ponds Z ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
0 s,
3 ❑ No Liquid Waste Management System a� r
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes $]( No
2. Is any discharge observed from any part of the operation? ❑ Yes V) 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 ® No
c. If discharge is observed, what is the estimated flow in gal%min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes R1 No
7/25/97
Continued or: back

Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons.11oldingPonds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes §9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:..........5.ldlr�................ "L�nh1^...................................
Freeboard (ft): ..........:Z. r 3 •�.............................
.......................................................... .................................... .... ................................ .............. I ................. ....
10. Is seepage observed from any of the structures? ❑ Yes 19 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12.. Do any of the structures need maintenance/improvement? 19 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
M No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............ 6Y'rt! uArb...........................S&Ctl`......4�x�t l4...............................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
tZ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
54 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EANo
22.
Does record keeping need improvement?
59 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
09 No
R, No.vialatioitsor. deficiencies-were;noted-during this:visit:,You:wviu ieceive:no.furttier,:.
correspondence d oid this:visit:•:• :: • . • ..: ;
Comments refer'totluesfioir.# Ex lain an 3iES answers im or au recorn endations or q yother cosminents M
Use drawEngs of facility :to better explai%situations fuse additional pages as necessatY)�, <� Si �'^�
_............
IT- l wO tt�rS �n saw �a�oLo��► SCOW be_1 ex6dj 04 4L ej atrtL'C Ibj w4 reie4f.`
1LP+c1C_
1
ti nV\W-/o,4yr dzt,, y,�p��� 5 01 �Gg00r� Snflt�C 3i� vNDW � fJ i�PSSti �'" W `C �- rtib:n c�rcn5
be
ori41 Tt`r"V- Oi�! ,,omits 6� 1004� � jvanz skovo Al wA c4�-
c 64 hl,)16 SInOU►tv ail ft1R�t t eac tt4LC0[�.
i�.��. (Q`O�y�S SUWti a %pve �i�!:Jl �itJkt iMpu''�,
W� f�r� Sa'k OA VKV l 5 1ovf f]
i �
zz. �x„e, el�c ir��°�� `0.vt 4 5r a Wcs�c 1 I�� sr�;s
'� y P ' °t' ? (P
fain �Ot �cuQet ci�`rw Sp1�0� Z C��i�icn
qq �!
recarLaS S t1}0 T
4P �e
►"ryhyilo,\ SYs�t}i.. sY+aUl tl' �6A• 7/25/97
Reviewer/inspector Name 77 s
Reviewer/Inspector Signature: Date: (/ )

•
Farm Na
Mailing
County:
•
•
Site Requires Immediate Attention:
' Facility No.. 6 S . Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD _
DATE: //_ 9- , 1995 �� y
Time: // l' � " G m Ym
Integrator: 1 _c- Phone:
On Site Representative: 6 Yy rn Phone:
Physical Address/
Type of Operation: . e.- Poultry Cattle
SD 41 -
Design Capacity:: ° ' Number of Animals on Site:
DEM Cerdficatib un er: C ` S DEM Certification Number: ACNEW
Latitude s '3" Longitude: 7.7 ° 6`Z) ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately -1 Foot + 7 inches) or No .. Actual Freeboard: a Ft. Inches
Was any seepage observed from the la oon(s)? Yes or 10 Was any erosion observed? Yes or No
Is adequate land available or spray? s or No Is the cover crop a equate? e or No
Crop(s) being utilized- c
Does the facility meet SCS minimum setback criteria? 200 Feet from wellings? (As or No
100 Feet from Wells? 1�p or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oroo
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, I ap li ,
spray irrigated on specific acreage. with cover crop)? Yes of'�� �� `� �r f�/jj'j", `
1 1�' l 1
Additional Comments: A D0 c j - c"', 61,1k�TouJ P S
Inspector Name Signature
41
cc: Facility Assessment Unit
Use Attachments if Needed.