670036_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
II

Type of Visit: Compliance Inspection U Operation Review O Structure Evaluation U 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: O Departure Time: f County: Dos h (bw Region: V/ Y I)
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: !F �rr�r� fJr I Yt sZi} Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: OHO b 4 X
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
—d
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oulti.
Lavers
Design
C•_a _aci.
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke
Other Turkey Poults
Other IOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes xNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ANo
❑ Yes'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

F/
Facility Number: u' l - 2 p Date of Inspection: IQ j
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ;'9No ❑ 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 Aonlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes'KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes KNo [:]'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 XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
A"
❑ NA
❑ NE
c
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 XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes XNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 "V_ "No ❑ NA ❑ NE
❑Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 21412015 Continued

Facili Number: - Date of Inspection: 111P111
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 o ❑ 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
KNo
&NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
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:
❑ Yes 0 No
❑ Yes V No
❑ 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/]nspector 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 No ❑ NA ❑ NE
Comments,( refer.to questiom# Explain anyYES answersandlor-.. any additional recommendations or. any;other comments
gs of f IUse d�awin actli to`better ex lain situations use additional a es"as neee""
b\NQ will crnvIr"l cud
vywat coh � c,wrer4 w, n%ra1, kl',c'Uh Lh kc,o(As .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: e? 7 90— [ Ja I
Date: f
2/4 ors

Type of Visit: ® CoPfpliance Inspection V Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access -J
Date of Visit: Arrival Time: Departure Time: County: ONSL,&j Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: WJLXtSS 7j 5t=gjs 6►J Integrator: -}
Certified Operator: Certification Number: Z09
19
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent
Capacity Pop.
Design Current Design Current
Wet Poultry C►►opacity Pop. C►attle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I iNon-Layer
I
Dairy Calf
j(
Feeder to Finish
IG00
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
D $oult_- acit P,o Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eefBroodCow
Other
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes jNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes Vvo
o ❑ NA ❑ NE
[:]Yes
❑ NA ❑ NE
❑ Yes [DNA ❑ NE
Page I of 3
21412015 Continued

t" Facili Number: - Date of Ins ection:
Waste Collection & Treatment
5
•4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
0 Yes
❑ No ❑ NA
❑ NE
Structure > Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .95
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EyNo ❑ 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 I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /1� ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
24
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ NA
❑ NE
Required Records & Documents
l9. 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
Yes
❑ Yes
❑
L No
❑ NA
❑ NA
❑ NE
❑ 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 2fNo ❑ 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 Vo
❑ NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes d o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rNo
o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes U1140 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1fj ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 1'J o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain anyYES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
l I�I�C� NEED �L e6� ��✓
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone ? i �j " 3w
Date: 71
2/ 1201

Type of Visit: (5 Volu-It"i"In
ce Inspection V Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit:e 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 7 Arrival Time: L-0 V-S--7 Departure Time: p� County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: /+-ofr, `S o N- 4�SOCi Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
ean to Finish
Design Current
Capacity Pop.
WePoultryK
Layer
Design
apacity
Current
op.
Design Current
Cattle Capacity Pap.
Da' Cow
ean to Feeder
Non -La er
Da Calf
eder to Finish
k-
2�
D , P,oul
Layers
Design
Ca pa
Current
P,o ,
DairyHeifer
Cow
Non -Dairy
Beef Stocker
rrow to Wean
rrow to Feeder
rrow to Finish
L!Fe
lts
Non j a ers
Beef Feeder
ars
Pullets
Beef Brood Cow
her
her
Turke s
Turke Poults
Other
I
E
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ ] o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
B"Slo
❑ 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

+ I Facility Number: C,7 - Date of inspection: 77 7 ,f'-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �10 ❑ 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: '2K/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ o ❑ 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 E] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [v]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 [9 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 0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): — �) & Q . R u (— ,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�f[No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Ei ""' ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes B—No ❑ NA ❑ NE
❑ Yes [+�No ❑ NA ❑ NE
Required Records & Documents
Yes
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
E
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2-No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E-go
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

aciliNumber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [t. C ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Q'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ 'No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[] No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ErNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ef No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[EI`No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E3"No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other.comments.
Use drawings of facility to abetter explain situations (use additional pages as:necessary).
C.�-
M. I AV t
O.C.O.C, Pe L,-• �. (C c o r f( -S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Iia(1Q1_�
Phone: ? ! () 71 k 7-Ny
Date: 7
21412014

Type of Visit: (dMORRoutine
pliance Inspection V Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: s Arrival Time: rT7TT--] Departure Time: Ew!= County: &&A Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: M0.n,&-i !� Qll,�s6j
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Design
Current
Design C►urgent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C*urgent
Dry Cow
Farrow to Feeder
I) , P,oult ,
Ca aci
P,o ,
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I jBeef Brood Cow
Turke s
Other
Turkey Poults
11 Other I I JELLOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [-]Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes ❑ o ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
EI/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
J
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 01�
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
C3/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation Poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks; or compliance alternatives that need
❑ Yes 9/'
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes L-LVl"o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VNo
❑ 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?
❑ YesVNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA FINE
Page 2 of 3 21412011 Continued

Facility Number: J jDate of Inspection: Zd J
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [ o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes t:]�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CTNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [gl o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [E]No
❑ Yes ETNo
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C3 N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes ❑' Rio, ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 6 4u ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -
Date:
21412 b11

,f
Type of Visit: (D Co pliance Inspection Q Operation Review 0 Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency C) Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: pNJLjV,1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: y Title: Phone:
OnsiteRepresentative: �](}�s brlj_"6N Integrator:
Certified Operator: Certification Number: ZoIs r�2
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish y
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Wet Poultry Capacity Pop.
ILayer
Design Current
Cattle Capacity Fop.
Dairy Cow
Non -Layer
DairyCalf
Design Current
Dr. P,oul Ca ac.i P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facilify Number: - 3 Date of Inspection: 3 a-I13
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[—]Yes
jo
❑ NA
❑ NE
8. Do any of the structures 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 C2r/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
q
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]o
❑ 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
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ej No
❑ NA
❑ NE
the appropriate box.
❑W1JP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑O er:
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 ❑ t 20 Minute Inspections ❑ Monthly and V Rainfall Inspectioallo
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ /No
❑ NA ❑ NE
Weather Code
Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 41 - Date of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z(No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [3-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:
[:]Yes No ❑ NA ❑ NE
❑ Yes [2/N� ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes ❑ 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 it)
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary)...
,ZQ 06rD T° Do SL✓OBE EV& _Shi 30SA ff.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( 9b -7,3g0
Date: Z 7 �3
21412011

Type of Visit: 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: L Arrival Time:r7r� Departure Time: County: v/d LD u Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: MpRA:ys j3Q_rW56P'j
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish Layer
Ca#tle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult . C•_a aci_ Pao
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
I 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[:)Yes Wo ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: & - Date of Inspection: f Z
Wane 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
T66
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[—]Yes WNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F2/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [/] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
E5/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Yo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ 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
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: f S I,-
24. Pid 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
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
PXN(o NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
WNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
N [DNA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
ZN�No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ 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 recommendations. or any other comments I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon
Date: % ,� Z
2/ 01

r.- - Division of Water Quality
Faei l -V Number L.'1 (, Division of Soil and Water Conservation
Other Agency
Type of Visit Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. f I I Arrival Time: Departure Time: County: i0WIL46Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:r�ti
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine g Capacity; .Population Wet
❑ Wean to Finish ❑ Laye
❑ Wean to Feeder ❑ Non -
Feeder to Finish tz
d0
❑ Farrow to Wean Dry 1
❑ Farrow to Feeder
, ❑ Farrow to Finish
7'10 Gilts
er.
Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = S = Longitude: = ° = & =
1.
Design :.Current^;; ^�
Fultryu;
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ DairyCow
❑ Dairy Cali
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E!(No
❑ NA
❑ NE
❑ Yes JNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 6'r — pate of Inspection 3
ri Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 12 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 EfNo ❑ 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? El6d Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes l2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
l 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ['No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
NA
El
❑ NA
❑ NE
Vr
o
❑ NA
❑ NE
❑ NA
❑ NE
Wo
o
❑ NA
❑ NE
Comments (refer to question_ #): Explain any YES answers and/or any recommendations ormany other comet" nts
Use drawings of facility to better explain situations. (use�additional,pages as necessary)
AL
Reviewer/Inspector Name Phone: l� L �73
Reviewer/Inspector Signature: Date: 3464
2 3 12128104 Continued
Page of

Facility Number: — Date of Inspection
} Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP.readily available? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desigri El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNo
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PdNNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C3 N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ No
❑ NA
[I NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1 ] 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
El
❑ NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
—/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El YesWN
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:��
Page 3 of 3 12128104

Type of Visit Qf ,Coo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C1 Routine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % Z Arrival Time: Departure Time: County: 6,Vr .cj4_ I Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (V10M1 t_aS t5 lLZ:,�uSQ ,) _. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ 6 = Longitude: = ° = i =
Design Current
Design Current
Design Current
oultry Capacity Population
Cattle C►apacity Populatiinish
7Feeder
121
❑ La er
❑Dai Cow
eeder
❑Non -La er
❑Dai Calf
Finish l�-{
❑Dai Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ 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 L/1 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
[:3 NA
❑NE
El Yes
El Yes
7NoCl NA
El NE
El Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:(o —3(p 1 Date of Inspection
4' Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: JA(MM22
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yL1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2(No. ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes LI 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?. El Yes L7 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
0"No
❑ NA
❑ NE
IG No
❑ NA
❑ NE
Ld No
ElNA
ElNE
o
El NA
❑NE
WNo
El NA
El NE
Comments (refer, to question #). Explain any YES answirs and/or any recommendations oi,any other comments
Use-iirawings of facility fo bettei ezplaii situations. (use additional:pages as neeessary) , a
.q _^
i
7
Reviewer/inspector Name ,rQrtnJL tL ;_ = w
Phone: ?1D
�7 $�
Reviewer/Inspector Signature:
Date:
Q
Page 2 of 3 1 12128104 Continued

+ Facility Number: — Date of Inspection--
t+
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ElNE
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 ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather
Code
"'El
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
C"1 No ❑ NA
❑ NE
- 23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
WNo❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
YNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes WNo
�o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes ❑ 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
dNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
WNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
Zo ❑ NA
❑ NE
Additional Comments and/ok Drawls s:
12128104

G
Type of Visit (F Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance 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: JN'S� U Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: MORK15 Q ELAIS0J Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d = Longitude: = ° = =
Design
C*urrent
Design Current Design Current
Swine Capacity
Population
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer I
I
1 ❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dai
❑ Farrow to Feeder 1
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures: F
❑ Other
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ['No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
�&
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection .? 0
4aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: lA(Y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA
❑ NE
(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 environmental7eat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
]�NNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑WN
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
E(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I[J No
❑ NA
❑ NE
Comment (refer toquestton#)Explaut any_YESanswrs andlorn�y recommendations or any otE►er comments.
PUsc.dr wtngs:of factty to better exptam s�fuatsons (use a"ddrttonal;pages as necessary. ): , -
-;� �,..
Reviewer/Inspector Name 1 atJ o , . Phone: —
Reviewer/Inspector Signature: Date: ✓a S. 6 el
"_- 1 , r 2 17/7R/4d rn„t.H.,od
-.5

1_
Facility Number: [ — Date of Inspection - o
.t
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Mans ❑Other
Cl Yes dNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
ElL JRainfall 1 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility 1fail to install and maintain a rain gauge?
❑ Yes
[3No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E] Yes
EiNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ICJ Yes
❑ No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JL_%No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
hd No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ 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
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or drawings:
Page 3 of 3 12128104

Division of Water Quality
yr=iN.Umier` Division of Soil and Water Conservation
Q Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5 5 0 b Arrival Time: S Departure Time: County: _d/✓, Qkj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �j Title:
Onsite Representative: 6.?ktj l3ktAls6d
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c 0 6 = Longitude: = ° =
Swine
Design CurrentpigDesign Current
Capacity Population Wet Poultry Capp city Pop ia_$tioon Cattle
Design Current
Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ La er
❑ DairyCow
❑Non -La er
El Dairy Calf
Z
aAiS
❑ DairyHeifer
❑ Farrow to Wean
El Farrow to Feeder
Dry Poultry El Dry Cow
ElNon-Dairy
❑ La ers
El Beef Stocker
La ers ElBeef Feeder
❑Pullets
El Turkeys El Beef Broad Co
❑ TurkeyPoults
❑ Other Number of Structures:
El Farrow to Finish
Gilts
PCI Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
04o
❑ 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?
ElQ Yes
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[21 o
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

:4
Facility Number: — 3 b Date of Inspection / d
I"
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
Identifier: olv
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3V
❑ Yes (3 No ❑ NA ❑ NE
[I Yes ❑No El NA ❑NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes C 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 dYNo
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El d l o [I NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes .fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes L5No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ,j, NN El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El LdNo ❑ NA ❑ NE
Reviewer/Inspector Name F�j 0Igo j FpaA/t.o— I Phone: 910 7f'—7 3 ��
Reviewer/Inspector Signature: Date: ,� a
Page 2 of 3 12128104 Continued

L.
A
Facility Number: 61— 3 Date of Inspection I Vj 3 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2�N El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
d1No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�jlN ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Zo
A
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No 2NA
❑ 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
fd CVO ❑ 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[2rNo
❑ 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 41'No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P'VU
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes614/0
❑ NA
❑ NE
Page 3 of 3 12128104

` OF Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit c4utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ZO 6 Arrival Time: Departure Time: County: olvrb l Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ii•1 I.5 ic7iV
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑o = [= fi Longitude: EJ ° 1--]' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�, �� ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 71
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ["No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
D-No
❑ NA
❑ NE
❑ Yes
j,/J No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of inspection T� e
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2Ko
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Struct`ury 1 Structure 2 Structure 3 Structure 4
Identifier _
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in): W
Observed Freeboard (in):yl
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E9<o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
L7 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [jKo ❑ 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 [3<o ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D<o ❑ 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
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,El,ilo
I_TNo
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
D o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;-Ko
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El0 yes
o
❑ 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):
2-slj S'vtIDGC -off G��+-y� ►��,� ��W1;Z oarA.i� �N�; frEd� ��� F(j�+""
Reviewer/Inspector Name t/LC (� 0 ; Phone•t (j /`9 3
Reviewer/Inspector Signature: Date: 3 LD Q
12/28/Od C'ontinned

Facility Number: '} — Date of Inspection Zb D
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections,,!! ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E3 o ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 No
❑ NA
❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
Cd o
ElNA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
CJ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�ETNA
❑ 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
Ejl�o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,��,,
IlciNo
❑ 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
Er/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[-IYesE
,,//
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ffNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

E
9
Facility Number
Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Co Hance Inspection
O Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
Routine O Complaint
O Foilow up Q Referral O Emergency
0 Other [I Denied Access
Date of Visit: �l f f_y _� Arrival Time: Departure Time: County: ok<< w t\ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ICE UR aX9 K. S (L.i. SOiz.> Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: =]' =' =" Longitude: = 0 0' = "
Design Current Design Current.`
Swine ' y'..Desig"n Curf re_if,;
CapacityPo Population Wet Poultry Capacity Population" Cattle Po latt;'_,
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish ate}$
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
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?
❑ 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 I of 3
❑ Yes /No❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E!No
ElNA
❑ NE
ElYes
/No
C/N o
❑ NA
❑ NE
12128104 Continued

i Facility Number:
Date of Inspection 1
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure �l Structure 2 Structure 3 Structure 4
Identifier: � (V20 zi
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 20
Observed Freeboard (in): 3Z
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? El Yes U No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [:XNo ❑ 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 1Vo El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, .Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ' S 60 L ir-1 S
13. Soil type(s) L 1J St.b W tj a LL foL ,_ /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [f 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 VNo
< ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ 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):.
l7 ,) 041-1-E 0 To gkEJ e, oW 5At- 'Q� W , MLAY FTCUD,
�
ZI �� IJ EC b ro vP p �i� G n-o t' 'e A wv+AL S T oCkWG
Reviewer/Inspector Name F '.v RAOCtL, Phone: 91
Reviewer/Inspector Signature: 9,26L Date: S-' 17 a!
Page 2 of 3 I 12128104 Continued

Facility Number: ) — 3 Date of Inspection I SIr►7I v y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑Yes wDNA ONE
❑ Yes ��No
o ❑ NA ❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applica �on ❑ Week y Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑
❑ Annual Certification
❑ Rainfall Stocking Crop Yield 120 Minute Inspections ❑ MonthIy and V
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
El NE
�No
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
O !Vo
❑ A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
❑ No
b NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
3� o
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LI iVo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Z<A
❑ 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
CXo
❑ 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
ao
❑ 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
�,, //
Ed 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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑Yes
VNo
❑ NA
ElNE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I
Type of Visit ,Co pliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C Routine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: LI I Departure Time: County: 0A(S4_A)_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: MoRR-T-5 QQ,-twj �
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� c [� I [� Longitude: = o = , 0 «
De i� C�urr�e t�De gn Current Design Current
Swine Capacity Prpulation Wet Poultry CapacttyK Population Cattle Capacity Population
n..v�ss�..z�,.��,.:��':9.,�"atit .,;ri�'e'k:S'..�xr,.rst,� R i=Fcrss,. _•,rer.:,:...,..s.a
❑ Wean to Finish ❑ La er -�� El Dairy Cow
❑ Wean to Feeder ❑ Non -La et I ❑ Dairy Calf
Feeder to Finish a NO El Dai Heifei
El Farrow to Wean �� El Dry Cow
Urryl'°9�u=
El Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑Lavers ❑ Beef Stocker
❑ Gilts ElNon-Layers "` ElBeef Feeder
❑ Boars ❑ Pullets
El Beef Brood Cow
c - ❑ Turkeys .�
Other [] Turkey Pouets
❑ Other F. ❑ Other Numher of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
LJ 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)
El Yes
No
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
,❑
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
7No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: �j�% — 3 Date of Inspection U a o 5
rNi-
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ld No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAG-ooyJ
Spillway?:
Designed Freeboard (in): Z!J
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0No ❑ 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 El NA El NE
El(
8. Do any of the stuctures lack adequate markers as required by the permit? Yes L►'1 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 Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ed/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L:J 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 El Evidence of Wind Drifl El Application Outside of Area
12. Crop>�e(s) 1J( WtUVAW S� (4W /So* fAd
13.
Soil type(s) 6
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 El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
,O
L�J No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
dVNo
El NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
CV� R+M b'0 KS (,r m'D.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: qr9117.
12128104 Continued

Facility Number: �¢7 — 3(, Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps El Other
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes VrNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E 3No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
d,NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
LdNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
dNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
to
❑ 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
2rNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,,��,//
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
eNo
❑ 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
Vo❑
NA
❑ NE
Additional Comments and/or Drawings:
12128104

iType of Visit ,f'Compliance Inspection O Operation Review Q Lagoon Evaluation I
Reason for Visit grRoutine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted jd Certified ©3nConditionally Certified © Registered
Farm Name:.....__ -A.
Owner Name: ... ........ 1!.1.�� ..........................................
Time:
Not Ouerational O Below Threshold
Date Last Operated or Above Threshold: ----- ...W��......
County:
Phone No:
Mailing Address:..__.. __. ..._..,. ------
_.—_....--W..._—.�_�.. � �.. .. ... .. _ ...
Facility Contact: ................................... Title:................................................................ Phone No:
Onsite Representative: Integrator: !").W—
Certified Operator: .,,................... ....... Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle []Horse Latitude ' ° 46 Longitude • ' 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZINO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -•-...... . .............................................................. .................... —....... ................................... ..... ... ....................... .............................. _...
Freeboard (inches): 94
12112103
Continued

i= 1
i Number:
Face � —'J� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes Q�No
seepage, etc.)
////
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes o
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 X No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes XNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes X No
I1. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes XNo
❑ Excessive Ponding ❑ PAN ❑ H dra •c Overload ❑ Frozen Ground ❑ opper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes /RfNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes ;3"No
16. Is there a lack of adequate waste application equipment?
❑ Yes 2f No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes PNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes/No
Air Quality representative immediately.
Comments (refer tef questron #) tExplata any YFS answers and/or a y recammendatioas ar an_y othercomrneats. _� µv
Use diswings'of fa�fy to better txplam situations: (ase �_ dttxonai pages as siecessary)e��[] Field COPY ❑ Final Notes '
QFSz �RE5Cn1 T Aem 17AwM
,V eV 1A0e_-ZC -19 7 45).)
QT4
T
,
Reviewer/Inspector Name
� tea"
Reviewer/Inspector Signature: Date:
12112103 Con hued

lE ad ty Number: !� —J( Date of Inspection t "
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0No
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 XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo
❑ 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 ,zNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
gNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
NPDES Perruitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
/No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

IType of Visit JZi Compliance Inspection O Operation Review Q Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up Q Emergency Notification Other ❑ Denied Access
Facility Number Date of Visit:
Q� Permitted 0 Certified Q Conditionally Certified 0 Registered
lw` rm N9mu• / \ i�/�] J rAa /io
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operated or Above Threshold: _
County: fi/06GCzJ _
Phone No:
Phone No:
Integrator:
Operator Certification Number:
Z Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 " Longitude ' 4
Design Current.
Swine- Capacitv,, Po ulatioi
❑ Wean to Feeder
Feeder to Finish
r° U Farrow to Feeder
r ❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca aci Po ulation Cattle` Ca acity Po vtation
❑ Layer I ❑ Dairy I
❑ Non La er ❑ Non -Dairy
❑ Other
- Total Design Capacity'-
Total SSLW
e F:
x .
Number of Lagoflns ' , ❑ Subsurface Drains Present ❑ Lagoon Area [I SprayField Area
Holding Pao %I_Solid.Tr�aps ��� i ❑ No Liquid Waste Management System '-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 'T"r
05103101
❑ Yes gNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �zNo
❑ Yes VNo
❑ Yes JZNo
Structure 6
Continued

Facility Number: Date of Inspection f-T
5. Are there any immediate threats to the integrity of any of the structures observed? (ic••/treees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? - ❑ Yes ❑ No
11. Is there evidence of over application? , ❑ Excessive Ponding ❑ PAN O Hydraulic Overload Yes ❑ No
l2. Crop type 1)A917u n4- I I . `7/77 /1`G L Cr->2A1Z IV l bl of24frn )
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
FfNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
SComments;(refer'to question'#) Explain any YES. ans%ers andlor-any recommendations or aoy"uther'commeats::'
-plain
1Cise'drawtngs of facility to better ex situations. (use eddthonal pages as aecessarS)
❑Field Copy El Final Notes
.a
r.4rJ509ECo,-) CnNDu a �C'l�us>E �F �.ro�=F Df
�4$rX G�•�Q
4f0Pj,ZCtj 7Z70tj
�
r
._ro_194/
F111
Reviewer/Inspector Name�1�
Reviewer/inspector Signature:
Date: 3
05103101 Continued

Facility Number: iP — Date of Inspection UPP
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Conathe©ts. and/or Drawings:
1AW
%Jq 4iJ,,,)G-
49
�p o,4
,JF'4'p /D
17114
Rv��D .dv � lU Div T - Fy Ail, ® � �•eD �- -.
n/O ,OF ts�/RF_ lif/f 7- Ala
i Fix Maj-111 SA "r1f r/A
05103101
lV

Type of Visit 10(Complianoe Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 Date of Visit: 2,0 D Time: 131
IQ Not Operational 0 Below Threshold
O Permitted O Certifiedr O Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County: ►'t SI o L✓
Owner Name: iy%A�r+" S �r�Dh l fa�p1i���Ph eo:
Mailing Address:
Facility Contact: $ Title: Phone No:
OnsiteRepresentative: mdre"s Integrator: 'i+/r�PI,..I—�foZ✓�`+
Operator Certification Number:
Certified Operator:
Location of Farm:
[]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & " Longitude 0 '
U Feeder to Finish
n Farrow to Wean
Other
Farrow to Finish
Gilts
Boars
Waste
Dischar¢es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
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 )!i No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collretion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ YesXdNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): Z b
05103101 Condnued

.�I
Z! 2aJzeo-7
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
❑ Yes )dNo
❑ Yes A No
❑ Yes �TNo
❑ Yes ONO
❑ Yes PNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? [j❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes gNo
12. Crop type t r ✓t^-� !� 4 ` r 1 S'""a. } �� /�Li -+ t� V� �3�e O�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes ffNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes FZrNo
c) This facility is pended for a wettable acre determination? ❑ Yes JZNo
15. Does the receiving crop need improvement? ❑ Yes x2fNo
16.
Is there a lack of adequate waste application equipment?
[]Yes ;2"No
Reaulred
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes )�J`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 0�40
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes 0No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes QNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ YesP�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ONO
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fait to discuss review/inspection with on -site representative?
❑ Yes �No
24.
Does facility require a follow-up visit by same agency?
❑ Yes �No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 01No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments,{refer to question #) Explains y YE&jAswers aadr 4k'ior ny r`ecom eodarions ©r anybo h r comment 's '` w
}❑
Use:drawin s of facih
g ty to betteE explarn situattons (use siddrhonal pages as recess ry) v
t„ _ Field Copy Final Notes
..
Wl r. T3✓;� say. yr a > JvS-} bd�� �k;S �a ram, C.v► f��►t - L,P ga�Y4 L.I ki .
/
e4v�-x) OW-1e.✓34;,- dv'-4, AT*,,. _rAere ;t
Reviewer/Inspector Name Sari"e• try ci .hi' S . s-.. `. 7w�; t t4 <
Reviewer/Inspector Signature: Date:
05103101 Continued

^flf
• Facility Number: 17-�� - Date of Inspection
Odor issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes I?fNo
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 XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �ZNo
32. Do the Flush tanks lack a submerged fill pipe or a permancnt/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:. �-
4
J
05103101

. r!
Type of Visit ,WCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit elo Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted [3 Certified 0 Conditionally Certified [3 Registered
Farm Name: R 57z) F Irv—,
Owner Name: f ` a D 4✓ h }r4 hf�0 '�
Mailing Address:
Facility Contact: �] Title:
j�
Onsite Representative: J w )14 ryt s! D _
Certified Operator:
Location of Farm:
`l 6Z Time: f 2 30
Not O ersti nal 0 Below Threshold
Date Last Operated or Above Threshold:
County: on-06 tij
Phone No:
Phone No:
Integrator -
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 09 Du Longitude • 6 �K
U Wean to Feeder
I
I
JU Layer
I
I jj_j Da'
eeder to Finish
jZqlfig
23j ❑ Non -La er I I JE] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ La oon Area
❑ S rnv Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
❑ Yes
ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Cl No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
X-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (inches): 3�
05103101
Continued

-6
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
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 ❑ Yes )2rNo
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? [:]Yes dN0
8. Does any part of the waste management system other than waste structures require maintenance/improvement? XYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 2(O
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ffNoLC
L'
11. Is there evidence of over application?jj El Excessive Ponding El PAN El Hydraulic Overload El Yes o.6 ire►!
12. Crop type 13er, rvtLAGE, b
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes _&No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZNo
b) Does the facility need a wettable acre determination? ❑ Yes ZNo
c) This facility is pended for a wettable acre determination? ❑ Yes ZNo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONO
❑ Yes ONO
❑ Yes ,fNo
❑ Yes -EfNo
Yes ❑ No
❑ Yes 2(No
❑ Yes &No f
R1J k
❑ Yes ,Io .mil
❑ Yes ZNo
❑ Yes Z"No
Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comneats�referto uestion Ea lain an TES answers and/organ rec mmdat�ons o`r".:an other c' m'mepts a `r x:
q P _ Y . � ,- Y. ��
Use drawings facil#y to better 'situattons. necessary)
of expiair {use additional pages as ❑Field Copy ❑ Final Notes
.; r:
34 e of 4h2 S��'ih�1e' ;►► 4he P;Gid-f rgr'ficvIctr( 'Ire ���
�' bets b ��;�� b�� }de -� la�a�►� leek When ,x rtO
re5, vVe12[d . �Ue� 40 imA e. Y►-tpp��'�; t44 rls -�p art -flue
/p�
Irl-c'n 1QR4 i
0 N ln/ q5 4C, a &AA 1� s 1 S Din-Ied� L., : � h ; h r� Q do yJ D�' arf 1 %ca
ewc), j.s 4p C,011eV 144e, 4 ►e r114.,v5tn gfflied orr 4he -19n-2'S.
Reviewer/Inspector Name AV,e-_,C,J} M,24zls
Reviewer/Inspector Signature: _ �� Date: 3L2 '70.
05103101 Continued

6 Date of Inspection
Facility Number: —13 7 OZ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ,f No
❑ Yes 2J No
❑ Yes ONo
❑ Yes ;?(No
❑ Yes JffNo
❑ Yes ❑ No
Additional Comments. and/or Drawings:=;«
2S. NeeA 4e -Pol[ow gvjdA-,cg GP1 wAsle plain rgle.s 4 da.tes
Per.- ler W, oi,,s-mAH Ornilv, oveorsved% H
T1.e Fa c; I „E.1 q of Ceo ps Ave nc�Jl J ke rl. .
NI, e= Gyre-'qJ7 6%WO'1 "J5 ne�'J we1.0"P 0"1>y�a cr'14 sod lesl
reFO>r4 .
O5103101

�q,Drivision,of Water Quality
Division_ of Soil and Water Conservation 2
0 Othec Agency:
= T_
wt
of Visit V Compliance Inspection O Operation Review O Lagoon Evatuation
Reason for Visit ]0 Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number IDate of V isit: - UI 1 imc: ® Printed on: 10/26/2000
NNot Operational Q Below Threshold
'Permitted © Certified © Conditionally Certified 13 Registered Date Last Operated or Ab ve Threshold
11
Farm Name:W11G�—`'�.. County: Q......... t, ......................
�.... ..............................................................
OwnerName:.......................--.................................................................................................. Phone No:................................
Facility Contact:.............................................................................. Title:....
Mailing Address:
Onsite Representative:.. 6L't"e'� ..................
CertifiedOperator : ................................................... ..........................
Location of Farm:
Phone No:
...................................................................................... ..........................
Integrator; ......&&I, rLl. ..
Operator Certification Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude 0 4 Longitude �• 6 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy I I :�d
Feeder to Finish aft-($ ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑-Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes b�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. 11' 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 pan of the operation? ❑ Yes JXNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 4No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes bf No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idcntificr:............................................................................................................ ........ .................................... ....................................
Freeboard (inches):
5/00 Continued on back

acility Number: '1 —3 Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(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
9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
19 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
b 'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
KNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
J�No
b) Does the facility need a wettable acre determination?
❑ Yes
kNo
c) This facility is pended for a wettable acre determination?
❑ Yes
�4 No
15. Does the receiving crop need improvement?
❑ Yes
VNo
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
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ No
(ie/ WUP, checklists, design, maps, etc.)
1KYes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
No
• (ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(�j No
24. Does facility require a follow-up visit by same agency?
❑ Yes
J No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
.; �cio •yiolafid6s :oi- deficiencies -were noted dtWing this;visit; - Y:oir :Will-r, eceiye Rio fuilhl - : -
: correspondence: abotit this visit...:..:::.:..:: : ::..........:..:..:..
Comments -(refer to question#): Explain any YES answers: and/or any recommendations or any otfief comments.-
Use drawl- of;facility to better explain situations. (use additional pages as.neces
V II`—�"� ��W+ �'..� tC \ •--vCr �+/� y[it�ir
C.
Reviewer/Inspector Name `)k?ckt,_
Reviewer/Inspector Signature- _11� Q _ Date: q — i _0( 5100

-4 Faciltty Number:_71 — Date of Inspection Printed an: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below kYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes )] No
❑ Yes [ No
❑ Yes No
❑ Yes '-No
ElYes 1PNo
r
❑ Yes KNo
Additional- Comments and/orDrawings: - , ,-
�c, C'= of V-'Z
S " - -& -�
L� � 1 , G�
t n�
Imo►-`-��t l �G u s� � �8p � -- �-�� s tN� l� ��30 �► e i �� e
c,
5100

*. :+ Division of Water Quality-
0 Division of Soil and Water Conservation
Q Other Agency _
Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit$(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number r] Date of Visit: Mff--00 Time: �Q Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted Cj Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ..................
Farm Name: .......... County:.....!^..�?......................................................
........................................................................... _
OwnerName: ................................................... ........................................................................ Phone No:......................................................................................
FacilityContact: ............................................................................ .. Title:................................................................ Phone No:...................................................
;Mailing Address:.......................................................................................................................................................................................................... ..........................
Onsite Representative: V'!-�'Z,,,.,.„. Integrator: , ��.,p
..................I.......................... "'U"'' 1....................................................
Certified Operator: .............................................................. Operator Certification Number: ..........................................
Location of Farm:
f#_
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� Longitude �• �� �«
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Ca aci Population Cattle Capacity Population
❑ Wean to Feeder
❑ Layer I
I
❑ Dairy
Feeder to Finish
C{t-(
❑ Non -Layer
JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lag -on Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
I. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field [:]Other
a. II'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) El Yes ❑ No
c. Il' discharge is observed. what is the estimated liow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JWNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes � No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure Z Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......................................................................................................................................... ........................... ...... .........................
.....
Freeboard (inches): �TI
5100 Continued on back

Facil''i Number: 9 --16 Date of Inspection 7/21/2000
Printed nn:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [I Yes ( No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J%No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes %No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes W No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes eNo
Waste Application
10. Are there any buffers that need maintenance/improve ment? ❑ Yes XNo
It. Is there evidence of over application? 1❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes ANo
12, Crop type I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes [� o
16. Is there a lack of adequate waste application equipment? ❑ Yes �`No
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?
:: 'Vo-yiolati6 is 0* i dehge.nfapWqrh6ced- d&itig this:visit: Y:ou .viil •i-ebdW b6 further; ;
•:•coriesporidence:ab"fthis visit.:-:•:-:•:•:•:•::::::::::•:•:•:•:-:•:'.•:•:•:•:':•:•:•:•:•:•:•:•.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to 1better explain situations. (use additional pages as necessary):
nj
DG+.. �G o�GClo sc�� rev
-� ­ 15 L eA
❑ Yes NNo
❑ Yes ttNo
❑ Yes j(No
❑ Yes bj'No
[-]Yes . f'No
❑ Yes XNo
❑ Yes RNo
❑ Yes WNo
❑ Yes 391 No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
}--ems 3goo
Date:
��
5/00

FacAity Number: 4r7— -1,<' Date of Inspection F4& &o
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanendtemporary cover?
P<Yes ❑ No
❑ Yes No
❑ Yes qNo
❑ Yes f�(No
❑ Yes kNo
❑ Yes q No
❑ Yes RNo
e W
-Additional-Comm W r
A,

' Division of Sail and Watier`Conservation -Operation ,Review
-_
0 Division of Soil and Water:' Conservation - Corriplianee Inspection -
Division of Water Quality- Compliance -Inspection
0 Oth' cf-Agency - Operation Review
IQ Routine Q Complaint Q Follows jjp of IDWQ inspection Q Folio
Facility Number
IxPermitted ❑ Certified [3 Conditionally Certified [3 Registered
/rn
Farm Name: .............................
Owner Name: _....QW1.IV.:..1�...........
of DSWC review O Other
Date of Inspection
Time Fri' Inspection I Cf:?(:3 124 hr. (hh:mm)
) 1 Not O erational Date Last Operated:
Countv:...,.O(J ............................
Phone No�.....1.✓.,.1.'..I.a.`.�!�!Q j��:3l�li��>
Facility Contact: ..................................... ... Title: ...............................
Mailing Address: ............................................
Onsite Representative:..OWL"e✓
....................................................I.................I......
Certified Operator:
Phone No:
Integrator: ....1,`
Operator Certification Number: •••....
Latitude r6 :r Longitude 0 4 "
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I 1 ❑ Dairy
Feeder to Finish ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-madeY
h. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimaied flow in Lalhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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'?
Structure I Structure 2
Identifier:
Frechoard (inches): ...........3. _,_
Structure 3 Structure 4
....................................................................
Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
NfNo
❑ Yes
JgNo
❑ Yes
[�`No
Structure 6
1 /6/99 Continued on back

Facility Number: -3EDate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes b6o
(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 tgNo
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? El Yes �No
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
NNo
Waste application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
tv(No
11.
Is there evidence` of over application`? ❑ Ponding ❑ Nitrogen
❑ Yes
Q'No
12.
Crop type ..............................................................................................................................................................................................................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14.
Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes
ONO
15.
Does the receiving crop need improvement?
ElYes
EXNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ANo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
'WfjiVo
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XfNo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
D(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes [XrNo
........................
No.vialations-or. deficiencies -were noted du'ring.thiiiWi.- You will-retceive nog further
• eor'resi)6 idence: about: this ;visit.: - ; - ; - : -: -: :: : : :. . . . . :
Comments.(reter to question.#): Explain any YES answers and/or anyrecommendatiods or any other comments."
Use drawings of faciliityao:better explain situations. {use additional pages as,riecessary) -:
Reviewer/Inspector Name
Reviewer/Inspector Signature: - 1 Date: 5 1' f 1 -7 1 1/6/99

Revised Apnd 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number -
Farm Name:
On -Site Representative: E­�c
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: � r pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility items) F1 F2 F3 F4
'V Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
M4I igation System(s) - circle #: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportabie pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, inclu�J�a depicting
wettable acres, is complete and signed by a WUP. -+�
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
w applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational.table in Part III)...;
PART 11.75% Rule Eligibility Checklist and. Documentation of WA Determination
Requirements. WA Determination required because- operation fails .one of the eligibility
requirements listed --below:
_F1 Lack ofacreage_whichTesultedxn:over�applicationmf-wastewater_(PAN) on:spray.
fields) accordingio farm'siastiwoyears mfirrigationTecords:-:
F2 UnclearjIlegible,-or lack of information/map.
F3 Obvious -field -limitations -(numerous Aitches;-Jailure A-oAeduCtTequired:-1-.,_-
buffer1setbackmcreage;--or25% of total _acreageddentifedan-_CAWMP::includes
: _
small 'Arregulad y-shaped - fields_ flelds-less-than 5acresfortravelers-or_lessihan
2 acres#or.stationarysprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER',2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
/ LL
{
FIELD NUMBER' - hydrant, pull, zone, ovpoint numbers may be used in place of field numbers depending on CAWMP
and type of irrigation -system., If pulls, etc. cross more -than one field, inspectorlreviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBER2 -must be clearly delineated on-iriap�
COMMENTS' -back-up fields with CAWMP acFe2ge-exceeding75% of its total:acres and having received less than 50%
of its annual PAN as documented in the farm's previous -two years' (1997 & .1998) of in-igation records -cannot serve -as -the
sole basis for requiring a WA Determination:Back-up fields must -be noted in the -comment-section�nd must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P9 Plan1acks-.following-.information:
P2 Plan -revision -may_satisfy-75% rule based on adequate overall PAN deficit and by
adjusting all field:acreage-to below 75% use rate
P3 Other {ielin process of installing new irrigation system):

[] Division of Soil and Water Conservation ❑ Other Agency
UDivision of Water Quality
Kj%outine O Com hint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection /
Facility Number
Time of Inspection ; 24 hr. (hh:mm)
E3 Registered JECCertified [3 Applied for Permit 0 Permitted 113 Not Operational I Date Last Operated:
Farru Name: t' ��4... County:........ t 7. ... ri�rh� ..............................
..................................................... ...........................................................
r t �
Owner Name: I!°�,1..%...1,R'� .. Phone No: Z �:�7....................................
J............................................................................
Facility Contact:..... 1tJ.6x........ ....: i,.l..� .. ..... Title:..... . ... ......... Phone No:......----....------..---..........................
Mailing Address: ..... .! ? v�%.h. ' .......2. ........... ..Jr. .e................................... .aS.. S..Y
Ousite Representative: ...... A2 g. :i7....--... j Integrator:.... .
�...........................................
Certified Operator, ...... A.V ........................ � ..................... Operator Certification Number..........................................
Location of Farm: J
0
Latitude • ' " Longitude ' ' "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
2. Is any discharge observed from any part of the operation? ❑ Yes Q�No
Discharge originated at: [I Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes V No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes EjNo
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 WNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
R No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
E.No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
Q No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ YesM
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
Of No
7/25197

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ,� No
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):....... , 3. �............................................................................ _........
......................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes A No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
:Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP��or runoff entering waters of the State, notify DWQ)
15. Crop type ...................i3. +4......----.....-...---..--..............................................................---.--.----..........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
1$. Does the'receiving crop need improvement?
f
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0° No violdtiohs' �ai deficiencies.were' -n' o' ed-iluring this:visit.- You;wiH rece'i've-no,furtliei-
: correspbti&ko dhoitt-this.visit
::::::
0112, V f s p -IV P•�N� i%'' 1�7�""f sP G , . > i kc-
ri `i �ic S (�•vc.�- !/H � �'� �S-ti%1--L-f ��-f�I�.,..
fiD Yes ❑ No
R1 Yes ❑ No
❑ Yes R No
9 Yes ❑ No
❑ Yes 0 No
❑ Yes 0 No
,lYes Ea
❑ Yes JZ1 No
❑ Yes No
❑ Yes No
dZiYes ❑ No
❑ Yes 0 No
❑ Yes jo No
❑ Yes 91 No
e�
ivC,0
7/25/97
I Reviewer/Inspector Name
I Reviewer/Inspector Signature:
Date:

ro Routine 0 Complaint 0 Follow-ug of DW!2 inseection
0 Follow-up of DSWC review 0 Other
Date of Inspection
Time Inspection 24
Facility Number
of hr. (hh:mm)
Farm Status: D Registered [I Applied for Permit
Total Time (in fraction of hours
(ex-1.25 for I hr 15 min)) Spent on Review
EM Certified El Permitted
or Inspection (includes travel and processing)
0 Not Operational Date Last Operated:
Farm Name:
county:
Land Owner Name: Phone No:
Facility Contact: Title:
.
........
.......... . .....
Mailing Address: --.CA v A Aa-uG..4...—..;A.) . ..................................j
Onsite Representative: ........ . ..... . ...... Integrator: —.11A.12a-elil ... . .... I. ..... ..... . ...... . ..........
Certified Operator: o-4 T
Operator Certification Number:
Location of Farm:
-Ij-a- n.jyy RW-1AaMUa!QA9 Y' ... 14A ......... U.N.... A�Q ...... L.MQ..M:t:Axs..
Latitude --. * ©, " Longitude 0 3Z6 14
Type of Operation and Design Capacity
23
�7 2M DesIgPCurrenE I
-n
ti avad 1311 0 atf�
-0 Ufa 'on e
❑ Wean to Feeder P Layer Dairy
10 Feeder to Finish Non -Dairy
VFT ❑_r ❑
nw,
A:
Farrow to Wean
0 Farrow to Feeder 121QesigMCapacity '
0 Farrow to Finish
FRAM
El Other
Ponds-e Drains Present k-
EjM
21, KOM M. Ir
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [:] Spray field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
El Yes RRo
0 Yes BNO
0 Yes ErTqo
El Yes &M
0 Yes FkKo
D Yes BNO
0 Yes 62NO
0 Yes O'No
Continued on back

FacilityLF2ciIity Number: ... (e T. Z .33....
A
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ❑1To
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures_1Lasoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
�.—. G- . ....... ..... __...... _
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes [Q-No
❑ Yes t9-710
❑ Yes BITo-
Structure 5 Structure 6
Waste AUplication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .... ........ ........... ....� ... '.............. . .... ...... ........ -_........... .............. _.... .._....._.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified FacilitiesQnjy
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes E o-
❑ Yes Cho`
❑ Yes ❑ No
❑ Yes B- o
❑ Yes Goo
❑ Yes Gi<
❑ Yes B-Ro
Q"Ves ❑ No
❑ Yes M-No
❑ Yes U-No
❑ Yes B-No
❑ Yes 63'No
❑ Yes 01-No
❑ Yes G]'No
(>ro c,,_SS cS-F &J1 :fo^S4,*4, A%C.CffSr X;P,,.frO 4
Hoc a -tU �ta� v•.7€tZ rQ►ilk Gpo A"'s7 �}�42z`�4frA��. Gl
r S L��� i�yrJT RT 'rH � s %1✓h.� .
Reviewer/inspector Name n:x� ..,,„ ��.,ffi;k I a
ReviewerAnspector Signature: I Date: Z %
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attendgn:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: � 3 , 1995
Time: °
Farm Name/Owner: � � G ray I 0� rv/v
Mailing Address: • 0
County: 1,oz,0
Integrator. (/ 1 Phone:
On Site Representative: Phone: Z " SY 2
Physical Address/Location:
Type of Operation: Swine V Poultry Cattle
Design Capacity: _ g M M Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 1/_° -3-L Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Ye r No Actual Freeboard:-" .5 Ft. & Inches
Was any seepage observed from the iagoon(s)? Yes No Was any erosion observed? Yes r No
Is adequate land available for spray? Yes or No I the cover crop adequate? Yes or No
Crop(s) being utilized: /.7 . 'S - W - 7&­
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin$rNo
r No
100 Feet from Wells?
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 9
ar9 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 Now, ]�
Additional Comments:
� u
Inspector Name Sim tune
cc: Facilitv Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: 'VJ0
Facility No..6,
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 r- -25 , 1995
Time: 31_ _ 3�
Farm Name/Owner:
Mailing Address: l
County: O 0 > c�
Integrator. i J _ Phone: tG 3­0 - 3S'83
On Site Representative: �ztl Cx� �R�'�� Phone:
Physical Address/Location: Nc afL 136.3 ^� d. 4` wJz r r`vvk k1CS-V0,+3o f
Type of Operation.
Design Capacity:
Swine Poultry Cattle
"z4fe• Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° 56 Longitude: '71 3 �_" Elevation:. Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: __Ft. Inches
Was any seepage observed from the aaoon(s)? Yes or�Was any erosion observed? Yes o` To
Is adequate land available for spray'. Ye r No Is the cover crop adequate? Yes r No
Crop(s) being utilized: co-A-s na., t r (ZNw jP A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?or No,
100 Feet from Wells? e�r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray, irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or CO 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 To
Additional Comments: ISt?tAS Ar 'D [ 1_s+4 c L.
w ktC_.�A /l _ p► y Q3 l KC SS CF kS S ��
IPVS13& WiA-w, S ri
Inspector Name
C
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 '95 15:17 F.11/18
Site Requires Irnmediate Attention it!a
Facility Number:
SITE VISITATION RECORD
DATE: r4zz 1995
Owner: - v r i A •✓ Farm Name: 4.aD
County:
Agent Visiting Site: Phone:li7loL Y.''-1't Vy*-4
Operator: != ayl�UrsTi..a _ - y Phone:On Site Representative-=.y Ha�rJt� _ Phone:
Physical Address: Tk-......�, �r==.�A.t.� ok. �x� .� .rerHe of Ga .e r/.o ....:�0. ."'y pf
A rir eOf .,,f.,41E•sT•r•r___ �4d. 'O' V.4• Z'r /w,.'. o ek* a424,r _
Mailing Address:
Type of Operation: Swine `� Poultry Cattle
Design Capacity: �zeft Number of Animals on Site. _. 4,vr
Latitude: " Longitude:" _,•, e '
Type of Inspection: Ground s.--" Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficicnt freeboard of 1 Foot f 25 year 24 hour storm event
(approximately I Foot +8 inches) 0551 or No Actual Freeboard: —_ Feet .t Inches
For facilities with more than pile laszoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes oRS:NVas there erosion of the dam?: Yes o T
Is adequate land available for land application? Ye r No Is the cover crop adequate? : r No
Additional Comments:
Fax to [phone]
Signature of Agent