310691_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
II

Type of Visit: 0 Com ce Inspection O Operation Review O 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: ®j Departure Time: C�j 16 1 County: Region:
Farm Name: r .f.;?le �'1D j�i �''+ Owner Email:
Owner Name: ` rlorr('S n'trc.rp h L, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
� r ,
Onsite Representative: 19 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design
D . P,oult , C_a aci P,o ,
Dry Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes No ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
[:]Yes6�-'"o ❑NA ❑NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesJN�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

3 ( 6q
,Facility Number: Date of Inspection: / 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �� � � ( -tiff
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;2 l�
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 ffNo ❑ 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 reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Vr VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EJ o ❑ 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 ❑ of Wind Drift [] Application Outside of Approved
Area
,Evidence
12. Crop Type(s): I�CSYn�sO y �Q.gq 1�+.yh��
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
LEJ '�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
��N
❑ 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
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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: ,g .Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes <No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 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 N NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments
Use drawings of facility to better explain situations (use additional pages as necessary).
vf� l �lyarc� fd-IJ —l� Sa 1 t. d 5 ��� L%.a d C�n�Q� Pl✓C
S 1udgLo sit -per -r5-P7 l l a= 3 vF
P = (� • 5 I
P= Ll �y
Reviewer/Inspector Name:
Reviewer/Inspector Signature: � � � :5 70-W e-- V
Page 3 of 3
Phone: � (1 -7 ! Z06
Date: / Z - 7
21412015

Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up Q Referral p Emergency O Other O Denied Access
Date of Visit: 'Z Arrival Time: Departure Time: County: Region: Q l�
Farm Name: v . Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Doe Vnby-
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: yy]
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Finish
Current Design Current
Pap. Wet Pointry Capacity Pop.
Layer
Design Current
Ca##le C*apacity Pop.
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
PF
DairyHeifer
o Wean
o Feeder
Finish
Design Current
l) , P.oul Ca aci Pao ,
Layers
D Cow
Non-Da'o
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
I ITurkeyPoults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes _No ❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [,,dNo ❑ 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 ZNo
❑ Yes eNo
❑ Yes F,24o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: t 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2 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
/ 3
Identifier. Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �2No ❑ 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 12:rNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ff No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ff 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 J�jNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jEtNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes
o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ 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 _CZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes JZ'-No ❑ NA ❑ NE
❑ Yes Z�No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑/ ' No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ 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

FaciliNumber: I 11)ateof1nspEq!n 0-4-22110
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[2No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�No
❑ NA ❑ NE
the appropriate box(es) below.
T
❑ 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
,fNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ONo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes t2011O
❑ 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
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes j2fNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes j2 o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑/No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ NA ❑ NE
Comments (refer to question #):-Explain any YES answers and/or any addltionat recoininendations'or any. other comments.,
Use drawings of facility to better explain situations (use: additional palles;as necessary.).;;;
Reviewer/Inspector Name: ��Jt, ` �,�j� J Phone:9jQ ig(a —1323
Reviewer/Inspector Signature: _ ,[� Date: 6 a G
Page 3 of 3 21412015

Type of Visit: Qrrompliance Inspection 0 Operation Review () Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q ' Departure Time: County: / .n/lam Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Design Current
Wet Poultry Capacity Pop.
ILayer I
Cattle
Dairy Cow
Design
Capacity
C►nrrent
Pop.
Wean to Feeder
I
jNon-Layer
EEd
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry, P,onl ua aci P,o ,
ILayers
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
113eefFeeder
Boars
Pullets
Beef Brood Cow
0-flier,
Other
HTurkeyPoults
Turkeys
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)?
❑ Yes T No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes E�'No ❑ NA ❑ NE
Identifier:
St1 trructur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
r � —��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ ^]
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1-7jNo ❑ 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 j2No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes JZNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (�No ❑ NA ❑ NE
maintenance or improvement? r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZN o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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):
I4. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes ZNo ❑ NA 0 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes iONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;2rNo ❑ 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
[;KNo
%
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E24o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V No
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,fNo
❑ 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
eNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
&No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes B No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes jEfNo ❑ 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 E� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JE�`No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ,Fe] No ❑ NA ❑ NE
❑ Yes V�rNo ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes d No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
T 34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any ether comments.
Use drawings of facility to better explain situations (use additional pages as necessa
Z z
2! off
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
oe ed s
e {e35 [V- ePC-- r ,
re- c-ot-cXy
9aC)d
Phone: WG 6
Date: 19 ��-
2/4/2014

Date of Visit: Arrival Time: Departure Time: County: Region: 1;`
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Integrator:
Certification Number: /03
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
oDesign Current
Wet Pultry Capacity Pop.
Layer
Design C«urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I El
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
MDesign Current
D . P,ouI Ca aci P.o .
I Layers I
Dry Cow
Farrow to Feeder
Farrow to Finish
Non-Dairy
Beef Stocker
Gilts
Non -La ers
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)?
❑ Yes JZNo ❑ NA D. 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 ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ETNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili umber: - Date of Inspection: - .►
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
12114o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
;2-No
%
❑ NA
❑ NE
Structure 1 Stru ture 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PNo
❑ 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
;TNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes %;o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �TNo ❑ 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 off No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,E5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
/�' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
-%No .
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
KNo
❑ 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
❑Waste Application ❑Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F acili Number: - Date of Inspection: r7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
k25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes TNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -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 ;6 No ❑ NA ❑ NE
❑ Yes ZINo ❑ NA ❑ NE
❑ Yes �3 No
❑ Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 7No ❑ NA ❑ NE
❑ Yes R�No ❑ NA ONE
❑ Yes A No
❑ Yes VfNo
❑ Yes EfNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (referto question #): Explain any YES answers and/or any additional recommendations or any other,comments..eUsedrawinffs of facility to better exnlain situations (use additional oaQes as necessarvl.
Reviewer/Inspector Name: itlL
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -� I ~e)'"N
Dater
21412011

Type of Visit: 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Of Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: ' (}
Departure Time: L -L-1
County:
Farm Name-.
�"Q�y � V'�
/ Yr
7 Owner Email:
Owner Name: I V�D1nii�
WV Q f{
�l
Phone:
It U
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region:12�1 E
Onsite Representative: y% sZ1Y'` Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
C►urrent Desigu Current Design Current
Pop. Wet Poultry Capacity Fop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
Non -Layer,
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
lt . Ca aci_ P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkez 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 ErNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes 0'No
❑ Yes 5�'No
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No
❑ Nk ❑`NEis '` _
❑ NA ' ❑:NE' ''
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1481 14. 2
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Ef No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ,,LZNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Ap licadon
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �TNo
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge 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
F
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rFo
F
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes r No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;EJONo ❑ 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 ZNo ❑ 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

G� Facili - Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9No
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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 reviewfinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
j!j No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
PTNo
❑ NA
❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
,EJ No
❑ NA
❑ NE
❑ Yes
�allo
❑ NA
❑ NE
❑ Yes
?r No
❑ NA
❑ NE
❑ Yes
Jallo
❑ NA
❑ NE
Comments (refer to, question #): Explain any YES answers and/or any additional recommendations or any.other comments:
Use drawines of facility to better explain situations (use additional paces as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:-31
Date: 5) M I 3
21412011

I
Type of Visit: AComphance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: X Routine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Time: Departure Time: County-tN
Farm Name: 1 �_AYE:J:Tj,e � M A0,1AS Owner Email:
Owner Name: UxS Phone:
Mailing Address: J o[ C J F L-k t -669 75OC 'R-50
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Kkkc A LASS// FV- Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region:
Design C*urrent Desigu C►urrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
airy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
E]
airy Calf
Feeder to Finish
a Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult . Ca aci. Pao
Layers
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts �(
1. Is any discharge observed from any part of the operation? ❑ Yes IX I No ❑ NA ❑ NE
Discharge originated at: ❑ Structure [3 Application Field ❑ Other:
,T�
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [] Yes 0 No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility Number: >j - Date of inspection: �f J
w
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: T `
IA Ao I RD
Spillway?: n
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes '5LNo ❑ 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(OOutside of Approved Area
� �C`1`-( � r
12. Crop Type(s): ��` LS C(� (p1 � � O'l 10)1� "1�
13. Soil Type(s): j A1(LQ QlLCf_ Y -F I AK,-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes TNo
o ❑ NA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
QWUP El Checklists 0Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
[� Waste Application Q Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ "ste Tr s rs 0 Weather Code
0 Rainfall 0 Stocking ❑ Crop Yield Q 120 Minute Inspections [] Monthly and 1" Rainfall Inspections ❑ Sludge Survey
�r-
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
Page 2 of 3 21412011 Continued

Facili Number: i - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yesj No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
—Acryes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
" NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendationsor any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary):
U'D, [ , .
H4a
a w a., s
Aeeo oo G F ED j �L a w l��� D Y.
Ol o�
)LP. NEC-D CGP oP 'g I
5
-�
r��uu C_ 1 o c.� oN �--���
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 96 - I r4 --9
Date: K MQ
21412011

L
Type of Visit: A Compliance Inspectiou 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: 5 I Arrival Time: Departure Time: County: '1 `c ,.C( _I N
Farm Name: \�"EA VEN Tf . I pCC M FjC (zM S Owner Email:
Owner Name: ! ' 1 [ ut i c, (,l a �Tly(� Phone:
Mailing Address: S c INN C l�Al.=_ 1L8 4cZe 1 S /7C C— D S"`
Physical Address:
Facility Contact:
Title:
Onsite Representative: 141quLi4 ! Mt -TT/
Certified Operator: Mn ay4 S VQ("Q µ"A
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integ�rator:
rtificatj
Ceion Number:
Certification Number:
Longitude:
Region:
Design Current
Capacity Pop.
PT!
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
Non -La er
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
J
D , P.oult .
Layers
Design
Ea aci_
C►urrent
P,o ,
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Beef Feeder
Non -La ers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: j -G09 El Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'V�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ a�
Spillway?: c
Designed Freeboard (in): � _ l 1 . S
Observed Freeboard (in): S >L+ 35
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.) 0
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? 0
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 W 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 J. No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window t �❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type{s): 1 9j�tiZ--6h 1 FSCtAE (9 �770/J
13. Soil Type(s):
14. Do the receiving crops differ
those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ Yes No
❑ Yes I
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Yes ❑ No
Yes ANo
❑ NA ❑ NE
❑ NA ❑ NE
QWUP ElChecklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ Waste Ty
ers 0 Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - (q9 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No N 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 0 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 4 No
❑ Yes kNo
❑ Yes AfNo
❑ Yes JNO
❑ Yes o
❑ Yes o
❑ Yes �'No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑kE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments:(refer to question #): Explain any YES answers and/or any additional recommendations _or any other comments:"
Use drawings of facility to better explain situations (use additional pages as necessary).
F GbC. ON NEXT 710AJ TOMO(Z"w ..
--� i�A-0 I'S 1.9
-
11a4110 6,74 H 0 -'5 �- S
Sly (f
of t_S�T �F� / /4 `use -rN1 S FORS
C-OLA-Ec i SNOT,*ER Fad- �11
Lr`.�C-
- LkpA T� l a/9!/la IFo�- P"`
— kj? 9A TC--
�E�r�aQIctN6 CI! BAk Spo7S q�C06'WVs �t E��5�o� Ra�.wox�o�sus
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ����J iO 3�
Date:
21412011

Type of Visit ACompliance 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: Arrival Time: 00 Departure Time: County: u Region:
Farm Name: F'1EA�y otm � ' �2(Y] Owner Email:
�j � g r�
Owner Name:fri-1 S �� 49.6,C) "CA - Phone: in 56J.,
Mailing Address:-
y'
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 5 N
Back-up Operator:
Phone No:
e9ojo
Aerator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: 0 ° ❑ ' = "
Design Current
Design C►urrent Design Current
Swine
C►apacity Population
Wet Poultry C►apaci1 Population C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer ❑ Da' Calf J.
❑ Dairy Heifer
Feeder to Finish
LJ Farrow to Wean
Dry Poultry ❑ Dry Cow
ElNon-Dairy
El Layers
❑ Farrow to Feeder
❑ Farrow to Finish
El❑Beef Stocker
❑Non -La ersEl Pullets Beef Feeder
❑ Beef Brood Cowl
❑ Turkeys
Gilts
PE]Boars
Other
❑ Other
❑ Turkey Poults
IFI Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
xNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility �umber:31 — lo 9
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?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 1 /A M 1' I {-i A -IrL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�1
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 1A No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA FINE
Structure 6
❑ Yes Ifi 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 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? hA
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1ANo ❑ 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) S C', �j CZ-MAI SV-\
13. Soil type(s) u lukuII UF_ 1 5 `1 DS cQ_c�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
1,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0.No
❑ NA
❑ NE
4:':
Comments (refer to question#): Explain any YES answers and/or any.'recornmendations or, any other confinenis •,
Use drawings of facility to better explain situations: (use additional pages 'as necessary).
GW_1?JW T)0/V WgS�E W 0V409� (�LE14S�CAl1IPC�7E t�ITh}lN ��A sof5�r1QTO:
A-TTN: AAPA,DA C 0010VE S
)VLD�
►� Ca¢�WB� V2 &-r. a FA-X 'r0
t.� w6TO vz AIC-
T o CQOP CALGC� *- j c v F-&CO MS
Reviewer/Inspector Name �( _ Al [ 5 - _ Phone: qj(� ` 510 3 d .
Reviewer/Inspector Signature: Date: N 16
Page 2 of 3 12128104 Continued

Facility Number: 3 — &q f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA XNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. 0 WUp 0 Checklists Design � Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers ual Certification
EIRainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Codc
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (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 11 No
❑ NA
❑ NE
❑ Yes )ANo
El NA
❑ NE
AYes ✓❑`No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes )�No
❑ NA
❑ NE
ElYes El
�NA
❑ NE
❑ Yes
*No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
KNo
[]NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ff] No ❑ NA ❑ NE
A��
X> ,(F- iN 1,,V5PrcT"W
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sji�l/a
11 j9'5A3'1
U1110,1
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FpQ C..195 Y -1,weE c.t q.AfZS 1.n1
6boK _ 0y.4 09 i{aAl
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�
-VAC-le-op W A, - CoO�A�s OFF a2�� P
��P
Grp FER raruOrd G , j F.1AUE 0/./E cxt rw IFECoRDS
12128104

Type of Visit Acompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: hoc Arrival Time: C>d Departure Time: County: Lw Region:
Farm Name: , i"tC —s Ykpue)y / `T 4 Rr-- Owner Email: �� p
Owner Name: �nn�S Phone: 943�—x`_J°
Mailing Address: qcq ) NE 0 E LZ E_ IZTS(3,V IV C QE'S
Physical Address:
Facility Contact: _ Title: Phone No:
Onsite Representative: Jo FLACW 1 C- i�- Integrator:
Certified Operator:
Back -up -Operator:
Location.of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o [ [" Longitude: 0 ° = ` 0
Design C•urreot Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
an
❑ Layer
El Dairy Cow
❑ to Feeder
❑ Non -La er
ElDai Calf
Feeder to Finish
❑ Farrow to Wean
j
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑Beef Brood Co
8Gilts
Boars
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 1 of 3
❑ Yes *o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

r
Faility Number: 3 — Date of Inspection l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 1A No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ij f!� 'T—AA I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ 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
maintenance/improvement?
Cl Yes 19No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
)No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Area
, /❑ / a
12. Crop type (s) S _G � r ��4- p C a-41— P� CC) ��S C_ A(
13. Soil type(s) U 1 LLC PA -I /V S G' OL-Z)g QCA�C3 - - - ----
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
'KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? 4 Yes
�(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
;kNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
gi No
❑ NA
❑ NE
Comments (refer to�Tynespon #) Explain an} YES answers and/ar any recomritendations or any other comments
gym.a .
UsiArawings of facility to better explatu "situations (use additignai+pages as tiecessary)
,.
TM1
H14)
�ARG
`
(Q l,109 LO
D. U
a.
al,-- )t39 R
'O.--
a- 8,
m9fl o's •�'
� - �'
1 •�-
�s
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

1
Facility Number: — qr! Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes j No ❑ NA ❑ NE
the appropirate box. ❑ WUP [1] Checklists ❑ Design 0 Maps ED Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P(No [:1 NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis -E] Soil Analysis ❑/aste Transfers ❑ A4nual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield E3 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
l�
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (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?
C_f�C oon� GCS ► e N Al 0 G�� To ( w]
cZQe ����a NFc[�5 TK-) Q>F_ �QZP1
❑Yes
14No
El NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
54,No
❑ NA
❑ NE
❑ Yes
', No
❑ NA
❑ NE
❑ Yes
t�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Earx
S l o.1v p-GZoL'nr P�N \4'e E(�) NC ON
o
at fn C l _ Ac7, 0 c
Page 3 of 3 12128104

I
Facili,3 Number 3 y (gcj j
Division of Water Quality
0 Division of Soil and Water Conservation..
O Other Agency
IType of Visit )0, compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance (K I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: % Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: , , f ,Title:
\
Onsite Representative: nPN/V u 1. Hi1� 1
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 4 = Longitude: 0 ° = S = fl
" Design '`Current Design Current
Swine Capacity population Wet Poultry Capacity Population
❑ Wean to Finish Y ❑ La er
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish 05700 T
'T ❑ Farrow to Wean Dry Poultry
[] Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[] Boars
<.Other
,• ❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
. a. Was the conveyance man-made?
Design Current",''
Cattle Capacity Population<,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
fKNo
❑ NA
❑ NE
❑ Yes
P(No
❑ NA
❑ NE
12128104 Continued

Facility Number: — 1 Date of Inspection 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 9 TNA I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll y 3 y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes WNo ❑ 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? A Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 �,;TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes DNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
kyNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IV No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
11�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RN
❑ 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):
RASS. o 5 w \X� w A LL .CA= � 12051 o>v j A z S c�AL
&(Z051c>V a/l S c.J c ocwCa_ o r (2,L_DG S J47 041
-FAA1 TcD /+4k3q_ MOwO�', b I/VSt DC
yr /VP,,6bS G Q.o5 icW COA['1`ZLo- - 1�,\Q `T w V Cz &TA-T-) GA!
Reviewer/Inspector Name I Wnizvv
�i� I Phone: U - j( -15� i
Reviewer/Inspector Signature: QnM222e _ Date: ( 0WO
Page 2 of 3 12128104 Continued

e'
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lq 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
IX No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�5 No
❑ NA
❑ NE
24.
Did the .facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ftNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ENNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
kNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ 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
[4 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
w R-Tci-) y3 Any �_L, owa/vcE_7 - P 4QwF-(z S c&N7ez pi uo i
n(caw S0QULV.' p �oTc-r�L 4Ppu«TJc)N
(=W P I E c-n 1 S= TRAC21- C90o(9 s/aJo� - �llAeneeg_
GIaN NOT Z E �LAC 41
l C CA� �' EPwIEpTi`' �d
I- S A- P L4 T GC,614 �x�v - �' S o N ��� s g �-� �nQpHw
Page 3 of 3 12128104

1 I
'if
Division of Water Quality
Facility Number j g O Division of Soil and Water Conservation
- O Other Agency
Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visii JJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I �/
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
County:
Owner Email:
Phone:
Region:
Facility Contact: Title: Phone No:
Onsite Representative: 0 /,AtJ Gf� Integrator:
Certified Operator: I %D 62Z! �p —Z224ffP_jfV Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: [= o = Longitude: ❑ o ❑ ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker,
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes YrNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
EJ Yes ❑ No
❑ NA
❑ NE
I
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
ElNA
ElNE
ElYes ff No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑NA ❑NE
S cture 1 S cture 2 Stfucture 3 Structure 4 Structure 5 Structure 6
Identifier: ZZ
—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes No
❑ Yes ❑ No
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 UlNo ❑ NA ❑ NE
through a waste management or closure plan? /
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
ElNA
ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
10
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 16 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /�'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop fWindow El Evidence ofWindDrill ElApplicationOutside
of
Area
12. Crop type(s) �,�iQ/YlU�R I l ei C1 R��/) . �,ESC!/ �4-z sl � I'a n or
13. Soil type(s)
i
14. Do the receiving crops differ from dose designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes/Z No ElNA ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes O'No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes A, No El NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes i�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):
7;�
Reviewer/Inspector Name Phon Z�
Reviewer/Inspector Signature: i ` Q!= Date: fflLeI67 Z
12,128104 Continued

_Facility Number: �1j' --��q� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )� No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. AeYes ❑ No El NA El NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis El Waste
%%%%{{{{Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking OCrop 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
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes )If No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes /No
El NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �No
❑ NA
El 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
ZO
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes XN o
❑ 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:
�- �Fis�7 ,F�oR i `�
p
�[
yo -, -_.,
11F l�� Cr �rC�M�G00IJ
p tc
Limp LLJ F7 c fv-,-
� -T— dcro e EA_ . Cy 1 L� s � �A v � 12128104

Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: f9j(7 I Arrival Time: ��`Departure Time: ounty: also Region: L4 �-Q
Farm Name: �� = Z Owner Email:
Owner Name: Z Phone:
Mailing Address:
Physical Address:
Facility Contact: Title.
Onsite Representative:
Certified Operator:
&tP'e1V'6q'Ln4W
Phone No•
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = f = u Longitude: = ° = 1 ="
esign Current
1-IDUP—a
Design C■urrentcity
Population
Wet Poultry Capacity Population
❑ Layer
ID Non -Layer 1 11
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 110,
Farrow to Wean
Dry Poultry
El Layers
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
El Turkeys
guythe
10 Turkey Poults
JE3 Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 31 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
y
ElNA
❑ NE
other than from a discharge?
I -
Page I of 3
12128104
Continued

:a
* . %
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 ,Sltructure 3 Structure 4 Structure 5 Structure 6
Identifier: � Z
Spillway?: wii FTn
Designed Freeboard (in): ���� L �� JC Zq
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Oyes ❑ 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 5Drift Application Outside of Area a`
12. Crop type(s) t'�F.EMU10A//I'dV �S 6y?Az! J,/ r0464 ��) &.2.v "'47.�
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
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
/V1
bNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1� 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):
�D} G/}GooN Y04 SZG.l1 FoOZ kglyN �%'H f_ C'pl1F�S, •
0 CL'e jBNj W 141n,,4�
j A/ e!j , 0
141) a)ng-
KR dqr
Reviewer/Inspector Name k �g
Phone:
Reviewerllnspector Signature: Date: tO
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LdNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. WrYes ❑ No ❑ NA ❑ NE
VWaste 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes X
No
ElNA
❑ NE
ElYes ONo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA 'ONE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
(� No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
y No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
El NE
El Yes
zNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
(49dlnle!,65,i
AL
/�iQ� 25 �02 2O6S Z r7b(o. ��Lc_ �� o
to /��,/D-�� z�oC/_
4e- SO /9AIV
L ne.►s 44"V,0
—F�r,� r��� No �z�� �� >z�,,� T �� oG✓ 41,7
Page 3 of 3 12/2&/04

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ; County:
Farm Name: G' A, �� / ' S Owner Email:
Owner Name: 0 Qt� A
�V - Phone- _
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
/j Region: 6�0'049
A Phone No:
Integrator: L Awl 3
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude: = c = 1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
Non -Layer --
Other
❑ Other.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
YI No
❑ NA
❑ NE
❑ Yes
ko
❑ NA
❑ NE
12128104 Continued

Facility Number: Z—
Date of Inspection
cp-144P5
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?
jyYes ❑ 1i 1 ❑ NA ❑ NE
Structure l Structure 2 ctuurre 3 Structure 4 StructurZ -5
Identifier: K X
2
Spillway?: A)o A49 O
Designed Freeboard (in): 9, _
Observed Freeboard (in):
S
❑ NA ❑ NE
Structure 6
S. Are there any immediate threats tot k, t an tructures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, err
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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? ;Z Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(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 A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �.No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )ZfNo ❑ 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 lip"
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area -;ros'
12. Crop type(s) 662,,w
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?
9Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
El No
El NA
El NE
A No
❑ NA
❑ NE
[dNo
❑ NA
❑ NE
VNo
❑ NA
❑ NE
V1 No ❑ NA ❑ NE
/rJF oS �� �,�o� Gr��r .✓ 2sGrSo�.es
Reviewer/Inspector Name Cog Phone: O— — G�
Reviewerlinspector Signature: Date: , !I
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f l No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check.. ❑ Yes Z No: ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ,Z Yes []No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard Z Waste Analysis Z Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall 0 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ 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
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�gNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
YfNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VfNo
❑ 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
[7No
❑ 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
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerAnspector fail to discuss review inspection with an on -site representative?
❑ Yes
;z No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
zXNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
20) ,440 Lid 42,kzea J na �.P�v� /?'1 /� Ate,
�/0/20 'p
it4D '5 I/5e A)c'04 o qua
AA 40
56D'�
- �sr Gym r on C'����e��•�
Z sad F ,jA AX �n� �Js>u A ass.
g.J �F2 /�'lL(�9, /Ye w C/�a�PS �i(/2y7 i Gib �i✓ ��%�
B� /)'1 �¢r=fit �5 /11�.FD to ,c�F� viR�� !�s �D •�� Lam, �io4
45)' o4jrew Goy !ems 1-1�04C-104 �� ,� %�,o /vle'$03 �� eme"ek,

of Visit j0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: I
[ 'ermitted,P(Certified [3 lC,o�n�dji - nally Certified 13 Registered
/Farm Name: ..... 4(1 �-------
3 Time:
) Not Operational O Below
Date Last Operated ,o�rDAbovThreshold:
County:..»._Q Jdl...�... ......» » ..».» ..». » »....»
Owner Name:... .».._...........» .»....»:........... » ...».._ » .» _. ..» . Phone No:
Mailing Address:
Facility Contact: ..__»...»._...»......... .........._ __.».W _» Title: -.- .. —.-. _. ».».._ » ».»..._» . Phone No:
Onsite Representative: ....... +'!„ _U._. »._ ._�_...... Int tor•
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 46 Longitude �• �4 66
Discbar2es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Su-uct e 2 S c re 3 Structure 4 Structure 5
Identifier: » ............ 1414 .»._».» ...._�`� :�..»........
Freeboard (inches): ] 3
12112103
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ Yes
No
❑ Yes
No
Structure 6
Continued

Facility Number: 3 1 — Date of Inspection 0
/NNo/
R 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
2(9
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
❑Yes
o
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type CSW Gc SCyO FsCVELG CUCU CATC"o)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o�
b) Does the facility need a wettable acre determination?
❑ Yes
2<
c) This facility is pended for a wettable acre determination?
❑ Yes
NNoo
15. Does the receiving crop need improvement?
❑ Yes
Z
L'f No
16. Is there a lack of adequate waste application equipment?
❑ Yes
o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes;N�
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ YesNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
Air Quality representative immediately.
:Cou aLs (refer to'geiestron;I#) Explaw any YES waaswers aad/oi' any recommeadafzon�s orany otli�eir comments.
se:drawings of faciLty to better explaw► srta�atwot : (use dit14;#1 pages as necessary) Field Copy ❑ Final Not �M w
23� (3E sc fo v s E Cme-E CT wAsrc. APR -ISMS Fo C R-)mPrr & EUftJ"r,
GLrt Si0�6- 2[�iR_1f�Ta�,
Reviewer/Inspector Name b -A%� ',7 w '
IIIY61 20JC .
Reviewer/Impector Signature: Date:
12112103 Continued

Facility Number: — b Date of Inspection PIV13/8
Rc uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes M No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes��/O
23. Doe ord keeping need improvement? If yes, check the appropriate box below. OYes ❑ No
Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes rlN,
c
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit? /
(ie/ discharge, freeboard problems, over application) ❑ Yes ©©zo-/
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ N
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes KNo
34. Did the facility fail to calibrate waste application equipment? Vy"
s ❑ No
35. Doe ecord keeping for DES required forms need improvement? If yes, check the appropriate box below. s ❑ No
Stocking Form Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. 71
12112103

.N:
Type of Visit 5D Compliance Inspection 0 Operation Review "0 Lagoon Evaluation
Reason for Visit o Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
I:aciGty Number Date of Visit: Time:
Not O erational Below Threshold
0 Permitted 0 Certified E3 Conditionally Certified D Registered Date Last Operate r Above Threshold:
Farm Dame: efe -A (/ -4 47 County:L/PZ.*V
Owner Name: L / J/�d(p i 5 hakogw � Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: S e
Certified Operator:
Location of Farm:
Phone No.
i
Integrator: ��/�, /1�uRPO.t/i✓
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude
- :Design : t Current d �_ :Desegn Ctarrenf`
_
Swine ' : Ca achy Population n-:Pouiti r Ca `acttv,. Pa islstiotn
❑ Wean to Feeder ❑ La er
Feeder to Finish -m ❑ Non-Laye
Farrow to Wean =-
❑ Farrow to Feeder `= ❑Other
❑ Farrow to Finish
r
Longitude a 0 0
Total Desigt
~ Destkm:
Subsurface Drains Present Jj[J Lagoon Area
No Liouid Waste Management System
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Y�(
es No
Discharge originated at: El Lagoon ❑ Spray Field El Other
rXJ
a. If discharge is observed; was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste ection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Stn4cti4re 2 Stippture 3 Structure 4 Structure 5 Structure 6
Identifier: 7-In— fij
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection /�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAj4 ❑ Hydraulic Overload
12. Crop type 41,04ff [, .F 5 l a
13. Do the receiving crops differ with those designated in the Certified AAmal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 0No
❑ Yes V'No
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes
Y ❑ es
6
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
ANo
No _
l�
No
Q No
No
WNo
�No
❑ Yes il No
❑ Yes �No
❑ Yes VrNo
❑ Yes No
❑ Yes No
❑ Yes E No
❑ Yes No
❑ Yes P No
❑ Yes XNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,ntiS111,: rya
Comments (refer to question #): Eiplain any YES answerspandlor°any recommendahonForony oE.her comments ;w ..
Use drawings of facility to better explatn_situahons.:`{use addrhonal pa�ges�asdnecessary) �^ ' Field Copy ❑Final Notes
w
77 SSLOEI JAL4 C v DF /}G'oi d
15 �Fcar, n,,E�o 1� G Sc Sri= /G
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 %_�r v Continued

j�-
Facility Number: Date of Inspection /9
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor 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
A No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
/
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
dNo
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
X No
31.
Do the animals feed storage bins fail to have appropriate cover?
ElYes
XNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/or Drawings:
/F) 61,7 5VO?6 /O (If f`i° V-'T �� ,s��et� �Goa�1 , � s
AWACO &49,W7- 1� ��
S P
4NA&
S�5 �itJ
z ooz 16P:Wr L off EL'q�1�5 ,C
L�',cc.
AV®,C� r Alf-101 �—
P 74-"7vV
0�15 - /18 15
O5103101

i<
Facility Number Date of Visit: Time: �Printed on: 7/21/2000 -
rQ Not O erational Q Below Threshold
Permitted ❑ Certified ❑ Conditionally Certified © Registered Date Last Operated o Above Threshold:
11 11 ,
Farm Name. [�Ci�c H�rw�`1��'�1 `�, County.......... « ..........................
.........................................
OwnerName: ...................................................................................................................... Phone No:.......................................................................................
Facility Contact:
Mailing Address: ............................................
Onsite Representative: �t sh2!,....
Certified Operator:
Location of Farm:
Title: ................................................................ Phone No:
..........................................................................................................................................
Integrator:... `
......................................................... ..............�.....s......
.............................................................. Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �4 66 Longitude 0 4 «
Design, Current Design Current Design C1111r1rM
nCacPoeaon nPoultCa ci Population .
Wean to Feeder ❑ Layer 10 Dairy
Feeder to Finish d ❑ Non -Layer ❑Non -Dairy
Farrow to Wean -
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity^'<
Gilts
Boars Total ! Sgi
Nuiinber of Ltigooas • ❑ Subsurface Drains Present ❑ Lagnnn Area ❑ Spray Field Area
oldrn8 H Ponds 7 Solid Traps ' Vz . . • , ❑ No Liquid Waste Management System - _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
S^^trr--uc:ture 1 S(truc ure 2 �uClurree 3 Structure 4 Structure 5
Identifier: .... ........7c. ................... 3.��.C..C... .......... ........... {�...............I... .................. .................. ....................................
Freeboard (inches): 30 �7 `ja.
5100
❑ Yes EfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes KNo
❑ Yes 9 No
Structure 6
Continued on back

IFacilfty Number: J — 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 WNo
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 maintenance/improvement? ❑ Yes NrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes NrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? BdYes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes NrNo
IL Is there evidence over application?
❑1Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ffNo
12. Crop type C�u l S�+�C r CGTTC�� . `fie c� i-rop y c . mac; rS4E�'fP�? . Cl2 r-A.fir
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
J�No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
kNo
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
N(No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
D 'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
,KNo
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
ff No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
kNo
(ie/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
NfNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ONO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
K,6.* olaiioris:or• di fciencies were h , 'd• doting #bjs;visit; - Y:ou will-i& K' iio further
coriespo deii& about: this visit: ' . ' . ' ... ' : : :
uiients (refer to question.#) Explain any YES answers andlor any recommendations of any other con>nl
ri p. . . _ -
dra m of facile to:better ex latn situations. (use addrtiopal{:pages as necessary} z
..
r � i�•r-t-,ee� � �pve w��e+r-2k�e.►-�ec� �e '��4c� `�c�O ��'c�tke
t.� 5-
°
v y sr
Reviewer/Inspector Name„v�
Reviewer/Inspector Signature: Date: S--Q [ 5100

Facility Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes kNo
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 'k 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 j 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 0No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IV No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
Additional omments and/orDrawings:,
Am
C"�t�
k �
CiLJ
d Gk '-� l.i �-•�av ,
5100

Division of Water Quality
0 Division of Soil and Water Conservation
- Q Other Agency
Type of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FFacility Number Date. of Visit: ��}i} Time: ® Printed on: 7/21/2000
Q Not O erational Q Below Threshold
Wermitted © Certified © Conditionally Certified [3 Registered Date Last Operated or lbove Threshold: .....................
FarmName: ...... La......A.q- ! ��................................................................... County:.D.Lr.h`.......................... I .... ............ I..........
OwnerName: ................................................... ................................................................... ..... Phone No:.......................................................................................
Facility Contact: ..............
....... Title:
MailingAddress:...................................................................................................
Onsite Representative: ,,`,,,fir^! 1.-- -
CertifiedOperator: .................................................. ..................................
Location of Farm:
......... Phone No:.........
..... Integrator:..��.....�....... _......................................................
Operator Certification Number:
IT_
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° �� Longitude �• ��r<
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish 16 i? d 6 JE1 Non -Layer ❑ Non -Dairy 1,
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ -subsurface Drains Present ❑ Lag -on 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?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance unan-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. Dries 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
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes WNo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Stir-u-ct�urre I Structure 2 Strucc{ture ; Structure 4 Structure 5 Structure 6
Identifier: ...........: r1..!.'....._..................T.J. .._ ..................
.�!..d..........._.................................... .................................... ....................................
Freehoard (inches): "13 a 8
5100 Continued on back

Facility Number:',] —',Cri Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
gNo
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
D'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Xyes
❑ No'
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
[—]Yes
XNo
11. Is there evideln a ofoverapplication? []Excessive Ponding ❑ PAN
❑ Yes
UrNo
12. Crop type LL-i LG4 C
to
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
I�KNo
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
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
P1f10
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
j (No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
bNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
j (No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
$No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
NfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 5'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes gNo
24. Does facility require a follow-up visit by same agency? ❑ Yes to No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes S9No
0: o yiolaitoris:or deficiencies were noted du irig phis:visit: You will receive rio; curl then
ctirr SD6:tidence: about this visit:....:...........:
Comments'(refer to.questibi .#). Explain any YFXanswers and/or any recommendations or any other,comments'"�
Use drawings o€ facility to better explarri situations (use additional pages as�necessary) h
{, K,,-1 C��V-4t t.J1+-:t 4a� ec e; L..e�s, �N�
A0 ���� cu e e_
CO-
Reviewer/Inspector Name ? , Q- . 3 �. ,
h e �J 395= i.. - `X�
W.� _
Reviewer/Inspector Signature: Date: 100

' 1Facilky Number:3ti, — Date of Inspection 64
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes A(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 XNo
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 RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes kNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes )No
Additionaomments and/orDrawings: _ - =-
J

1
p. Division of Soil and Water Conservation Operation Renew
r Division of Soil and Water Goiiservatiom TTComphance Inspectiod
ivision of Water Quality omplipnce Inspection
_. their Agency.,_- Operatic Reeve
Nuoutine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review ()Other
Facility Number Date of Inspection Z
'7oyo Time of Inspection -, 24 hr. (hh:mm)
Ed Permitted Certified © Conditionally Certified © Registered [] Not O erationai I Date Last Operated:
Farm Name: .
Owner Name:
...................
Facility Contact: .........................................................••-.......- .-.-..... Title:....
MailingAddress:. ................................................. ...........................
Onsite Representative:
Certified Operator: .................................................
Location of Farm:
...
- rr .......I ...............
County: .......... 1>. �.� t,.. �..4.................... .......................
PhoneNo:.......................................................................................
Phone No: ...................................
..................................................................................................................... ..........................
1s7..
................................ Integi-ator.......lW�, .:�...
................................ Operator Certification Number:..........................................
........................................... —. ----............................................................................... I...................................----.....-..................---...... -- -- -.... •..... '-
Latitude �' �� ��� Longitude • �� ���
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PrNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance inan-made'? El Yes No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes �KNo
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 P No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;dNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Pd"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t� ,,
Freeboard(inches):............................................................................................................................ ......� ....................................................5 ....
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes INO
seepage, etc.)
3/23/99 Continued on buck

Facility Number: 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)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type C, gG-C-, (14 k-IP ) /S. (6 . C-AJI C R. eo
v Zi
❑ Yes ONo
13. Do the receiving crops differ with those hesignated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
h) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
'(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �6•Vio1afions:or deficiencies mere noted• Aitring'4bhis:visit:- You wiil•reeeiye iio Ifui-ther
corresp6fide.nee... A' ,f this visit.
❑ Yes ?I No
❑ Yes VNO
❑ Yes 0 No
❑ Yes J6 No
❑ Yes �No
❑ Yes ONo
❑ Yes E] No
❑ Yes EfNo
❑ Yes 21'No
❑ Yes Z No
❑ Yes pr�o
.2ryes ❑ No
❑ Yes ,rNo
❑ Yes Rio
❑ Yes O1Vo
❑ Yes RrNo
❑ Yes ZN
[-]Yes
.�Jo
❑ Yes O�io
❑ Yes ZNo
Comments (refer to•question #) Egplain:'any;WYF.S answers andlor anyrecommendations o%any_6ih comments:.
Use. drawings of f tciltty:to better esplatn situations (*e.additional' pages as necessary) ; ` a -
'�l ffZX4;r'ae ,'c.'ri'ss �� + �.' Tp x P Pr �E �7 r5opr� r�G.
iCCU Pr cis{ y a� 'a`NE �e�c.,; r -J TN �+3- �C. �f
SOM& CAnr.a V k4me r4-'3 -.meet 0.Lc y
A �'et& s le -C . TQy T� C�F.�r- �l'e6�rgT'✓s` C..IF1z-
a ylOJs95�ya
Reviewer/Inspector Name ti]0t1 i►•i( =ni ' T_ I. _ T
Reviewer/InspectorSignature- T� Date: _A/Z% 9�
3/23/99

Facility Number: 3 — I Date of Inspection $ C
Odor .Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes JfNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes X�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ;3"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 <,0
31. Do the animals feed storage bins fail to have appropriate cover? ElYes NO
32. Do the flush tanks lack a submerged pill pipe or a permanent/temporary cover? ❑ Yes <o
At[dit . omments and/or Drawmgs
a ,
a
3/23199

0 Division of Soil and Water Conservation Other Agency
�» ® Division of Water Quality
.... � ..-.
Routine 0 Cam taint O Fallow-u of DW ins action O Follow-up of DSWC review 0 Other
Facility NumberDate of Inspection It z
Time of Inspection 1S' 24 hr. (hh:mm)
13 Registered © Certified 0 Applied for Permit ® Permitted 10 Not O erational Date Last Operated:
Farm Name: .ewe...... County:....P..0 r 1 a.., ..................................... .�..
OwnerName: .A..C.Y.. ..................... .�r.�.)n.................................... Phone No:...��1.L.�1�..... .�..�....... . .�.... .......... ...................
Facility .Contact: ......................................... . itle: ................... Phone No:
Mailing Address: .... S.A.2.r..... ..... .�.................... .. .1.�a.cnr.�Ci.�... lV..� ....I Z .. .Q. .... .........
r....
Onsite Repr�entative:... i�l.1 r.Y.1.S..........u..r.._,............................................... Integrator:....0 n �c . ...................................................
CertifiedOperator:............................................................................................................... Operator Certification Number ..........................................
Location of Farm:
Cl.trs.... lG.rr ....4->:.l�.aV.....5 i.d.¢ ..... ......5 . S.9.... 53..�!. rx 1e..► kx.�a .......... �i.:.s,S.....x�rt a.. U 3.....�1.�.:�Tiw.
..
t_ c- y C 1
.w.p_41.....C.�:... t.Y. �4 1.i.G.Y1....1Al.I. ...Sl.. .4.. ._4.7.........._........................................................................ .........
Latitude 0• 0' 66 Longitude ' • f «
Design Current Design � in
De"s Current
ys
'Somme r „ CapacityPapulatton Poultry CapacitylPopulahon Cattle _ Capacity Fopulahan
❑ Wean to Feeder
z Layer ❑ Dairy
❑ Feeder to Finish
` ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
❑ Other'
El Farrow to Finish
TOtai DeS�gn Capacity F
n: ❑ Gilts
F -n
❑ Boars
}' S
a
Number of Lagaans I Holding Ponds`© ❑Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
? r
> ❑ No Liquid Waste Management System
�..
---
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes IN No
2. Is any discharge observed from any part of the operation? ❑ Yes 10 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 91 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 ERNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes E[No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes B No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes IR No
Mai ntenance/irnprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IQ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ERNo
7I25I97
Continued on back

Facility Number: .31
S. Are there lagoons or storage ponds on site which need to be properly closed? •❑ Yes El No
Structures (Lagoons.tIolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 21 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: _.._..-...�.:................
Freeboard(ft):............................................................................ ..........................................................................................................................................
.
10. Is seepage observed from any of the structures? ❑ Yes JR 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? .91 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 RNo
Waste Application -
14. Is there physical evidence of over application? ❑ Yes ` 9[No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ,....................... �S.e ..> . ................. ts.............. .5�.�. !�.A -a� �rtd..........icA.Y.-ml .........a�?..�!�"�
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? RYes ❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
C?No
18.
Does the receiving crop need improvement?
E9 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
RNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
E[No
2l.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ Yes
CgNo
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
B No
0-No.violation5-or. d6ficiencies.were-noted.during this:visit.- You�will ikei ive.no' Airfller-:
correspondence about this.visit. ;
12• �4a�e °`''``� c- SQ. h try la.aa, "4.11 1
tl.0 {ar'j�� gvia�N�—y cet`io� ir. ,V (.,4,A- rt` � v�a� dAti ✓ a-i
6-o.44 t •+ • A-',S c� () � �� f-d'r � � �' V '•v`.� 5�,�
�� � I � / GD ✓ten
w.
d lJ a � � o� 1�-�-� �- i v� ti 1 1 jam. .i.�t..,,�.{ �o-.� v.-s �, � L l-o-�..�„� cs-✓lz �
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 61--A1 0 , , L-,JL-j__kk Q V. Date:

0
Site Requires Immediate Attenno�,T
Facility No. f
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �— 7 , 1995
Time: A
%2 3 // !/
Type of Operation:: Swine vPoultry Cattle (0'541`�f—
Design Capacity: _ '� Number of Animals on Site: 76)�C� -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: °E2 W Longitude:_Z° '` &L" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) or No A al Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes NJ Was any erosi observed? Qor No
Is adequate land availabl 4or spraynQZr No Is the cover crop adequate? 9, or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria?_ 200 Feet from Dwellings? 4-6s or No
100 Feet from Wells? Os or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 10
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o(9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
C�e .�
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.