310861_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual
II

(Type of Visit: Q Compi' a Inspection O Operation Review p Structure Evaluation Q Technical Assistance I
Reason for Visit: outine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: Z
Certification Number:
Longitude:
Swine
Finish
Design Current
C+apacity Pop.
Obi
Design Current
Wet Poultry Capacity Pap.
La er
Design
Cattle Capacity
Da Cow
Dai Calf
Current
Pop.
Feeder
Non-La er
o Finish
F
Dai Heifer
o Wean
o Feeder
o Finish
Design Curent
it , P,oul C*a aciP,o
D Cow
Non-Dairy
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Stocker
113eef Feeder
Gilts
1_113oars
jBeef Brood Cow
Other
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 No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [—]No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ NoDNA ❑ NE'
[:]Yes [;I ow ❑ NA ❑ NE
[:]Yes Fj-Ko___[j NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: I - Date of Inspection:
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �5 Z_
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 �[] 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 Z l; ❑ 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 [J"'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 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 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes EdNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes dN o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?,
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other: ,
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Sludge Survey
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ITID
22. Did the facility fail to install and maintain a rain gauge?
❑ YesZNoo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili N mber: - G Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FNo
<- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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 C N-o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No []'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No - ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes [ —ITo ❑ NA ❑ NE
❑ Yes
E o
❑ Yes
3-No
❑ Yes
E]'K'O
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pages as necessary).
Z
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: -9-7 17
Date: V /
21412015

S
Type of Visit: 0 7Routine
Hance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
w• r��� � w ��rr r r� ■ i ■ r r ■rrrrr■r i �
Date of Visit: Arrival Time: j t tcD Departure Time: Z; County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: y [% /� U ^ ^ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
an to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
77'Wean
to Feeder
2(.pQ 14"p
1 INon-Layer
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P■oultr. C*_a aci Po .
Layers
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes eN
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection- !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2—
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2`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 7 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 E ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LJ 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 Cf No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑�
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[-]Yes
7 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
[f No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dl�
❑ 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 EdNo ❑ 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 E No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E:rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facift Number: - Date of Inspection: It
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ,�JNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ]5No ❑ NA ❑ NE
❑ Yes E rNo ❑ NA ❑ NE
❑ Yes
EfNo ,
[:]NA
❑ NE
❑ Yes
[;J-No
❑ NA
❑ NE
[:]Yes
[ o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use dr'awings of iacili twbetter explain situations us6`ddditional pages as necessary).
F---/
1" 1" 100 �
S� (t,n) f-K/— CKrrC-f$
Reviewer/Inspector Name: D OV-1 � D. ' 4
Reviewer/Inspector Signature: �`l �'t--
Page 3 of 3
Phone: V 17��%Jp�
Date: it t r
21412015

Type of Visit: aCom epee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ❑ County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:'[ �e �t'lr y Lf/� _ T Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swlne
Wean to Finish
Design Current
Capacity Pop.
Wet PouIt-7
7yZ
RCapacity
La er
Design
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Z. oo
2 fd
Non -La er
I
I
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D , 1;ouI
Layers
Design
Ca aci
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
r' N
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
Page I of 3
►l
21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in). Z 7t
Observed Freeboard (in): 2-7 1i
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes C]-NNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes � ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E N ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ©-IO ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes []'-No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 0N0 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [21&o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [!TNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? 0 Yes E1.36 ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ej No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E5"No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:,
21. Do 'record keeping need improvement? If yes, check the appropriate box below. ayes ❑ No ❑ NA ❑ NE
aste Application ❑ W kly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections [ Iudge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes En -No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [J"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

e
r
Facili Number: - Date of Ins ectian: a
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 ErYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
CU—.'F/allure 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 [3'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes To ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
❑ Yes 04o ❑ 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 %rNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [�No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
o t C'c-P loAle SGV-Ve'
r� l -[
11S3y
f o r ,7 (a Z + n� 1 YS
jt44A °t"5 � D_ 7
b l
V_ 4 6
rc e,`5
44
� e " V U � hu� 6u IDS
Reviewer/Inspector Name: -19a-11 ? ��r� Phone: [phone]
Reviewer/Inspector Signature: Date: 16
ln-
Page 3 of 3 21412014

ion of Water Quality
Facility Number - ® Division of Soil and Water Conservation
� Other Agency
Type of Visit: .Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County-.-.�
Farm Name: /' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:G,
Design C*urrent Design Current Design Current
Swine Capacity Pop. Wet Poultry C►apacity Pop. C•attie Capacity Pop.
Wean to Finish La er Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean Design Current
ltr.. C•_a aci P,o .
Farrow to Feeder rfNon-Layers
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes GR*No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes ,ET'No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ;Z'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 -Eno
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes �No
❑ NA
❑ NE
Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes ONo
❑ NA
❑ NE
of the State other than from a discharge?
ge I of 3
21412011 Continued

Facility Number: jDate of Inspection. Z 2—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,a. No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �o ❑ NA ❑ NE
5trucT l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes Eno
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ZNo
❑ 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 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;:JNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
'9No
❑ 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 1'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2j 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?
Reauired Records & Documents
❑ Yes �o ❑ NA ❑ NE
❑ Yes �To ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J:? No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4ETNo ❑ 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 13"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E5"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 04 o.. ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo ❑ NA ❑ NE
25„Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ,F!:fNo ❑ 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 21`No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 21No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes JzNo ❑ 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?
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'PNo ❑ NA ❑ NE
❑ Yes )Z No ❑ NA ❑ NE
❑ Yes jL;]o1Vo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [-]Yes �TNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes 16 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes L3/No ❑ NA ❑ NE
Comments (refer•to question ft Explain any YES answers and/or any additional recommendations or any other comments.,
tfi :Arawings of facility to better explain situations (use additional pages as necessary).
G .`76
o.cla
C ' '''V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Rat
AokCln to off..
Phone:
Date:
1412011

Type of Visit: "Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qoftoutlne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' Departure Time: County: Region:
Farm Name: i F Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:YLE 2p
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Capa.
Finish
MpFeeder
Design Current
Wet Poultry Capacity
La er Dai Cow
Design Current
Feeder
Non -La er Da' Calfo
Dai Heifer
Design Current D Cow
D . P,ault . Ca achy P,o P. Non -Dairy
ILayers t 113eef Stocker
Finish
o Wean
o Feeder
Farrow to Finish I
I
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I I Beef Brood Cow
Other
Other
Turke s
Turlce Points
Other
Dischar,aes and Stream Imnact5
1. Is any discharge observed from any part of the operation? ❑ Yes ;�J'No 0 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 f2rNo ❑ 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 JZ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes Y-No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection:
y Wastekollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes Zr No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: /
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): —�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes PNo
❑ Yes r No
❑ NA ❑ NE
❑ 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 ,E3'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes &No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5�`No - ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA FINE
❑ 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 [:2-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes g>o ❑ 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 �L o ❑ NA ❑ NE
❑ Yes 7j.Aio ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:)Yes ❑'No [DNA ❑ 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 eNo ❑ 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 PrNo [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 5)No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

i.
y�
Facili Number: - Date of Inspection:
. 24. Dili 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 P-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 C;;bNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;;?-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[] Yes E:jNo ❑ NA ❑ NE
❑ Yes AF,_0No ❑ NA ❑ NE
❑ Yes -jfr No ❑ NA ❑ NE
❑ Yes ZfNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P?'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes P'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VO
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
!r�y L1ria,�y 1.; T Pun^r"--s
4
G �S-e� 1<%z?lr .L
0--h !/
13 4fjC't4
, ral AIX � In 50001
aoo1
4rAlf
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone:
Date:
121411011

Type of Visit
Reason for Visit
Date of Visit:
Farm Name:
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
1W
)utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time: : Ci C% Departure Time: County:
1C K7Y1 I ,10"l Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: oy_�, -C F
Certified Operator:
Back-up Operator:
Phone No:
Integrator: /-n zz5
Operator Certi cation Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = 6 = Longitude: = ° 0 6 0
ig
Xe-s i
11 =DgeMin@�rrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Finish
❑ La er
❑ Dai Cow
o Feeder
❑Non -La er
❑Dai Calf
to Finish
❑Dai Heifer
rFd
to Wean
ultry
❑ D Cow
to Feeder
❑ Non -Dairy
to Finish
❑ Beef Stocker
Non -La ers
Beef Feeder
Pullets❑
El Beef Brood Co
El Turke s
Other
IIIEJ Other
❑ Turke Poults
❑ Other
Number of Structures:
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ 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
' ��N1 o
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ N1
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Coll, ection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [--]Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): !
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ ,CJ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) f
6. Are there structures on -site which are not properly addressed and/or managed ❑ ,�
Yes � No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA El 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;�(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 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�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ETNo
❑ 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 P(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Comments (refer io:que'stion #j. Explain any YES ansi►.Zes and/or any�recommendations°or any other comments. ;
Use drawings of facility to better explain situations (user dd tional pages as,ec sary)
e, �-
IReviewerlInspector Name Phone:
ReviewerlInspector Signature: /L Date: 3
Continued

Facility Number: — Date of Inspection 3
Reauirid Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;2'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 El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes -16No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2TNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Pmo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
X 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
ice'
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
EJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[7No
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional�Com ents and/or:Drawings
/4//� �- 2
-e i ttie, h
all fie ,Scr/ k 1L k_ aOv7
/ 6? e i u (c J, A
rffl-x '�- �'c'-O"P-&h levrI4 GOU/'
12/2&04

1'3r
Type of Visit QZompliance Inspection
Reason for Visit 0 Routine 0 Complaint
� s -
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Time:
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Departure Time: County: k Regionkj/z'ap
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: r Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = g Longitude: = c = 1
Design 11g;Design Current Designtion
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish La er ❑ DairyCow
❑ Wean to Feeder
LIFIEDNon-Layer
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Non -La ers
❑ Gilts
El Beef Feeder
ElBoars
❑ Pallets
❑ Turkeys
❑ Beef Brood Co
Other
❑ Other
Number of Structures:
❑ Turkey Poults
❑Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ 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
ElNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P'`No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
6/No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:. — (c', Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O�No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
12'No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r_ U
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
j2No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
,2No
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
J"No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EQ 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
El Yes
21'�O
❑ NA ❑ NE
maintenance/improvement?
I l . Is there evidence of incorrect application? If yes, check the appropriate box below.
[I Yes
,ter
{_1 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
[,—kNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q 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
90&o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P'No
❑ NA
❑ NE
Comiiments (refer to question '#): Explain any YES answers andlor any.recom endationsior an Anther comments. #r
Use drawings of facility to better explain situations (use additional pages as necessary) ,
s
Reviewer/Inspector Name --° Phone:
l�r G Ltd}
Reviewer/Inspector Signature: Date:
p
G Om D
12128104 Conlrnued

Facility Number: ` — Ej Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes p No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 011yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ,0 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ErNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
,Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PjNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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
WNo
❑ 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
JZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E!rNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ugo
❑ NA
❑ NE
(.4/74
! Uj-� /
- w�� le
I L Ild
117 14
40
J/"� - ?, tI. J� 1W //,4 *//
r No w50 1 ailalysl.s 000ce
a
je5/ 62Ga�
1eaSe J 7h� s e � r Ste° s �S Si
0"" /i rlw /O(j4 � a�
l2l28/04

Facility Number: Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J21No ❑ NA ❑ NE
the appropriate box. ❑ )ArUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 011yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ,0 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 ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes fNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
,0Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;(No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
FZINo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
PNo
❑ 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
JZNo
❑ 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
ErNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E314o
❑ NA
❑ NE
1,41 Glse�l Jay&4��
a
1) ,Soil
0 5 /ae& Sul !l �/ O�?' oo�
Se _14
i ��-
12128104

Division of Water Quality
FFFacifity]Number j O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: =Departure Time: �] County: Region: 4114�_
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: v
Certified Operator:
Phones No:
Integrator:/ 7
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
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
Latitude: =o =' =" Longitude: =° 0I = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design : Current
Cattle Capacity ' Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
i
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
J No
❑ NA
❑ NE
❑ Yes
[Wo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes PIo
❑ Yes ❑ No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed I El Yes �'No ❑ NA ❑ NE
through a waste management or closure plan? '�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ) ❑ Yes 2No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 El NA ❑ NE
maintenance or improvement? �'
Waste Application r!
1
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate b VeIow. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Groun ❑ He y Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN � 10% or 10 lbs ❑ Total Phosphorus ❑ Fai ure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Pio
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
0No
❑ 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):
A 7
Reviewer/Inspector Name Phone: t
Reviewer/Inspector Signature: Date:
I2/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑14o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. J2 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis oil 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 L�JNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ZYes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
J2NE
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
Q 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
�jNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,�J
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LI No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
rb No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
Nt7 960E
5011 A-S Ae,
d�) /Vo Ca���Yk iE,+� S Ljl-�, Pie45c br- 4,5
5
VQ►�L1 G� ��L'°.l.
(, L 0 ciLc C37or-
1
Page 3 of 3 12128104

I/
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit plioutine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
/7 o&6
Arrival Time: 9� G_
Departure Time: County: r
Region:
Farm Name: f l
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =' = Longitude: 0 °
Design
N.
Current
Design Current Design Current
Swine
C►apaci.ty
Population Wet Poultry
Capacity Population Cattle Capacity Population
Wean to Finish
Q ❑ Layer
❑ Dairy Cow
I ❑ Dairy Calf
❑ Wean to Feeder
1 10 Non -Layer I
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ ers
ElBeef Stocker
❑ Gilts
Non-Lay
❑Netsers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Turke s
El Beef Brood Co
Other
❑ TurkeyPoults
❑ Other
IEJ 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?
Page I of 3
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
12128104 Continued

.a
Facility Number: eDate of Inspection OE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑-fio
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ 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
["No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes J[2'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 0 Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,fNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes QIo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind ;Dn:ft,
❑ plication Outside of Area
12. CroP type(s) 6%%%�1�14;
A v
3. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CI -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes eNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes ET No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑"No
❑ Yes [-No
❑NA El NE
❑ 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): ,
arG� /9(5 A,
Reviewer/Inspector Name vt Phone:
Reviewer/Inspector Signature: ZiL_ Dater
Pape 2 of 12 28/04 Continued

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

I
Type of Visit Q-trompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q'Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
r
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Owner Email:
Phone:
�PPhhone No:
Integrator:%'YCL�r
Operator Certification Number:
Back-up Certification Number:
Region: - Lf
Latitude: = c 0 d Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
D
�;Wi! LEI Non -Layer
Other
❑ Other I-�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
FeMo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12128104 Continued

Facility_ Sumber: — Date of Inspection 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 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?
❑ Yes .FTNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,,(
9. Does any part of the waste management system other than the waste structures require El�CJ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2<o ❑ 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
ICI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;?,No
❑ NA
❑ NE
16. Did the facility fail.to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
.Q"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
jC20No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�Ko
❑ NA
❑ NE
\A epCIS
Reviewer/Inspector Name �' P�Q Phone:
Reviewer/Inspector Signature: Date: A p
1212VO Contdnued

Facility„Number: I? — Date of Inspection G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,W"No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ; yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists XDesign ❑Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. 2-'7es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield P"120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �10?No ❑ NA
❑ NE
❑ Yes ❑ No ,'NA
❑ NE
❑ Yes -[:]No Z NA
❑ NE
❑ Yes ❑ No KNA
❑ NE
❑ Yes B No ❑ NA
❑ NE
❑ Yes ❑ No ❑ NA
); <
❑ Yes /ETNo ❑ NA ❑ NE
❑ Yes O-go ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes ;2No ❑ NA ❑ NE
❑ Yes RNNo ❑ NA ❑ NE
12128104

(Type of Visit U Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit (3 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: �] Tune: !S�
Facility Number b
0 Not Operational 0 Below Threshold
© Permitted © Certified ©Conditionally Certified 0 Registered Date Last Operated or AboKvejThreshold: ..___............
Farm Name: ....._ . .A.0L-AT-L-4 .....�..---- _------ ..._------- County: ------- � .......... _... _ ....
OwnerName: ........... ................. ...... ........ . ....
Mailing Address:
PhoneNo: ................................. ....................... .....................
Facility Contact: Title: ...... ------------------- --------- --- Phone No: _....„ .. _. _._.,
Onsite Representative: ..... M4 w �� _ _ . _ Integrator:
.
.........._.. Tn tor: ......._....................................... ..
Certified O erator•.W..... _ .. __....__ ...._.___........_........ Operator Certification Number:.W,,,,,,,,,,,,,-, ,.._.,....w_.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 09 " Longitude • 4 cz
Discharxes & Stream Impacts
I - 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 ❑ No2. Is there evidence of past discharge from any part of the operation? ❑ Yes U<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes To
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1.r.......................................... ..... ....... ................... ...................... -.............. ............... ........... .._... ......... _....... .................
Freeboard (inches): 2 7
12112103 Continued

Facility Number: .31 —5?(Vl 1 Date of Inspection
•5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2<0
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 9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes to
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes DICO
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ;-No
'No
11. Is there evidence of over application? If yes, check the appropriate box below. El Yes
❑ Excessive Ponding [IPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C3�lZ.W+UdA l G-) s�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ['No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0To
b) Does the facility need a wettable acre determination? ❑ Yes ❑-l'f
c) This facility is pended for a wettable acre determination? ❑ Yes UlKo
15. Does the receiving crop need improvement?Yes ❑ N
16. Is there a lack of adequate waste application equipment? ❑ Yes Lj'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 :;v
eo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0
19. Is there anevidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes LTo
Y n PP g g g P
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 ��O/
Air Quality representative immediately.
'CO
Bents (infer to quesi�an #) E�iplarn any YF�fisans eis and/a� any �ecamm datzoas or any other comments. _
.r
Use dreiwuegs of faciirty W better explain szfuabons. (use addi�oaal pages as necessary) ❑ Fietd Co Final Notes ''"
,ptl _.. n.__�.:s s. - r:- r� - =�tl: .x, --ram e"'.,..�`t`_ �'a"�"."'�.'�s �`^-„�. �f .. m g'y'.: � ��r .,.1 _:+#,. ,a-e,x,-�:,. a �.�We*-...h-�_.. = PY ❑�.�,,.^�*.".»�xx _
s) I,IEE� CaNTiZD1. AN �' A 4p C.=N1E
2I)ram► CrE i
�� X
Reviewerllnspector Name _ISM°.1q� ��`�, -� a
Reviewer/Inspector Signature: Date:
!lllll03 [-ananuea

Facility Number: —
Date of Inspection 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25_ Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
I IDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
es ❑ No
❑ Yes l.d o
El Yes l J� o
❑ Yes �l
❑ Yes No
❑ Yes U"'
❑ Yes
❑ Yes 7No
ElY, o
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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 I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Faciliir- Number / Hate of Visit: /% Time: l
not erational 0 Below Threshold
M Permitted M Certtiifiedl O C/ofndittiijonally Certified 0 Registered Date Last Operated
dd]or Above Threshold:
Farm Name:
l ////l�L/1i��✓`/ _ - County
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No:
�/_
Integrator: 17414
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' Du Longitude ` u
Discharges & 5tream Impacts ��
1. is any discharge observed from any part of the operation? ❑ Yes 21 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (if ves. 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):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
El Yes O'tvo
❑ Yes s o
Structure 6
Continued

Facility Number: —
Date of Inspection D�
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?
❑ Yes ZNo
❑ Yes Eff No
❑ Yes No
❑ Yes No
❑ Yes P1 No
WasteiApylication
10. Are there any buffers that need maintenance/improvement? ❑ Yes Aj No
11. Is there evidence of over application? // ❑ Excessive P`ondingg /❑ PAN ❑ Hydraulic Overload ❑ Yes ZNo
12. Crop type p/� !t d C . Ji3l�(tl li��� s �4OrsIf
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,.,2I No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Ef 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
j2rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Regruired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
10 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
ZNo
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.
Nail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�ZNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�9 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
0 No vi6lations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments`(refer to question #) E=plain aby YESTanswers attd/or__any recommendations orany:otlter camments:_ -
Vie drawttii s of fac7ity to better expiatn s tuarians.Y{use addilYonal;pages s necessary) ❑ Field Copv ❑ Final Notes
_
#i fTi
,*or,';, o/ ZDDZ�
Reviewer/Inspector Name m m
Reviewer/Inspector Signature: Date: Z
051031OI � Continued
Ap 13 9 7-- 3�,O eFt

• Facility Number: Date of Inspection / 3
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 anv 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?
Additional_Conimentsandlor`Dr:iwiogs:
O5103101
❑ Yes ZNo
❑ Yes OrNo
❑ Yes ZINo
❑ Yes XNo
❑ Yes ICE -No
❑ Yes MNo
❑ Yes P No

ono ahty
I3rvrsi , #Water..Qu
�' ' * Q:Drvrsian of Soil and Water Coatron 5
0:OtherAgeney u. r
•
Type of Visit 6compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up Q Emergency Notification O Other © Denied Access
Facility Number Uate of Visit: Z Z 62- Time: �� Printed on: 7/21/2000
Q Not Operational Q Below Threshold
ja Permitted E.Certified
EConditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ... /K �7(.11......<.Y..ri?t ......... County:..._...!V�l��!i..................................................
Owner Name: ...... Azl_l....... ...............TI,N ........... Phone No:
................................................ .
Facility Contact: ..............................................................................Title:
Mailing Address:.... ................................................
Onsite Representative-
... hp✓.........
..................
CertifiedOperator:.....................................................................................
Location 'of Farm:
Phone No:
//� ..........................
Integrator: .oe;.0
......................................................
Operator Certification Number:....... ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 41 Longitude • 4 i �41
Design_' Current
t CanacifV . Population
_ Wean to Feeder
D
Z da
Feeder to Finish
Farrow to Wean
Farrow to Feeder
,ClFarrow to Finish
Gilts
Boars
Design Current Dew ` Current
Poultry Ca ci Population Cattle :_ Po Marion
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
10 Other
Total Design Capacity
Total SSLW
Subsurface Drains Present KI Lagnrw Area ❑ Spray Field Area
No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [ISpray Field [IOther
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 : .............. j..................
Freeboard (inches):
Z� !!
5100
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El No
❑ Yes ,3,10
❑ Yes E&No
Structure 6
Continued on back

Date of Inspections---J
Facility Number: 3 —
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
Z+No
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
El Yes
V.No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
M No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
lk No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
%No
elevation markings?
❑ Yes
Wasle Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
'01 No
11. Is there evidence of over application?Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ZNo
// \\❑
12. Crop type
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
,,{Q No
b) Does the facility need a wettable acre determination?
ElL� Yes
,No
c) This facility is pended for a wettable acre determination?
❑ Yes
R3 No
15. Does the receiving crop need improvement?
❑ Yes
®No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Re fired 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?
8No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
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
MNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
50 No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
59 No
24. Does facility require a follow-up visit by same agency?
❑ Yes
ED No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�..� ,: - - a 1 n � .:: a -., ► 3. `. .- r s �.�
Coinutents�(refer to.questroh #fj .Explain any YES';answers and/,q 1."y_r&ommenda'tionstor any otlrer,camments
Use drawings of�facility, to better explatnsitiratians: {use�addihonal, a es as neces
p g nary)
❑Field Copy ❑ Final Notes
s
G4�dOn Jrdl )l* MOO � � rn �d L'oy a°✓ �J���Sh r 0� � rll --- �Z/d�
7/v !✓G,5 It s `1tt LG IG u 4l e Va /to/-
1 �
fzo- 'al Dde-✓ ���✓JC��f�rt ho
/rho / r- -/ r AA ,_ ,* v- A?,o ll�od Z,,. Z-4
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: g 4Z
0510310I Continued

Facility Number: Date of Inspection Z z$
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or Iagoon 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 KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes &o
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 allo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IgNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [] Yes �[No
Additional omrnents an orDrawings:
5/00

Division of Water Quality
O-Divisionof Soil and Water Conservation
W = Q 0 Agency
e.
Other fi4 t1
�ro
]Type of VisitInspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: I
Permitted ❑ Certified ❑ Conditionally Certified 0 Registered
J �j
Farm Name: ....... ��?.'�.s!�....?.l..t.r11... ....6 r........................................................
OwnerName:O1 .............................................................................
FacilityContact:.............................................................................. Title:.........................
Mailing Address:
O� Time: � Printed on: 7/21/2000
0 Not O erational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County:
vr....1� n..........................................................
PhoneNo:.......................................................................................
Phone No:
Onsite Representative:.,. . ..,. .,..(!,'� `� .. g Inte rator m rl..�e � l`ti, ;�
'}. .......
CertifiedOperator; ................................................... ................................. ........................... Operator Certification Number:..........................................
Location of Farm:
Ur; wine 0 Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude
Design;, Current
_Canscity Paiomlation
Wean to Feeder
24, DD
Feeder to Finish
E
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nttupttlbei,flf Lsgob ❑ Subsurface Drains Present ❑ Lagnna Area ©Spray Field Area 1.
Halidmg Poudq / Sot>EdTraps'_ ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Z'No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes 11 No
c. If discharge is observed. what is the estimated flow in gal/min? -71
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yesn ;9 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -f'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'HNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Strucilure I
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 0 No
Structure 6
Identifier:
Freeboard (inches):
S/00
Continued on back

Facility Number: 3 — Date of inspection I s Printed on.• 7/21/2000
.5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONO
(If any of questions 4�6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes )9 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes I'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 P1onding ❑ PAN ❑ Hydraulic Overload [:]Yes A No
12. Crop type �,- rn uP1.4 6rq 7�. � <t i gr", t'-I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes -M No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Jf No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
pIrNo
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
A No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
fgNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)6 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
J;jNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative'?
❑ Yes
VNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Off No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�allo
:: Q yiolaiigris:or defcier�ci.. were noted during tis:v. ....will receive Rio turt�er
- correspondence. about. this visit. • • • • • • • • • • • • • • • • • • • • • • • • • • • •
nments (refer to question:0 Explain any YES answers and/or any reconnnendations.or any: other comments:.
draivi gs of facility to better explaui.situations { ise additional pages as necessary)
rcrloylkel a ire vey-y w efl * ef4'
AL
Reviewer/Inspector NameY7e LIV 11
Reviewer/Inspector Signature: �,� /i" N� Date 3 of 5/00

Facility Number: 3 r —��) 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
PfNo
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?
ElYes
ElNo
Additional, omments an or ramngs: , . c
A6

y�_,t 5 �� •-y r a . D1V1S1aR Of'Water Quality _ � � �'��. ,'ter � Ftr;� � � �_ +
Q
Dlvisian of Soil and •Water ConservaLoa''`
w
mac-.
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O'Floutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number e
Date of 'Visit i Time: r1 Printed on: 7/21/2000
Q Not O eratianal O 13elo�s• 'Threshold
Permitted Certified Q Conditionally Certified ©Registered Date Last Operated or Above Threshold:
FarmName: ............................................................................... ........ ..................... County
Owner Name: ... l.Yl' `. ...::"j� /Y Phone No:.... ......... ........ ............................... ................................. ..
Facility Contact: .... /�!1 ........... .] j�C....................Title• ®�/ lil� .. ........ Phone No:... I........1.i?... /..........
r
:Mailing Address:.._..._.. L . ........ ...... ....... lT% p ....Ab'............ A ....................1
Onsite Representative: ........ I.�... LY,Ii?.1.... ............................. .. Integrator:.........:.. ' ` .......__.._..........
Wka;g-
14a ..............Certified Operator:.....jg-zrl.L........................... Operator Certification Number:._.... .
Location of Farm:
GcJ. 1 v I��jp� y �-t1 • /J. 1d3 4 0/
� 7
❑ Swine [I Poultry ❑ cattle ❑ Horse Latitude Las]• ®4 DM44Longitude • 4 44
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
jffWean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
Z
❑ Gilts
Total SSLW
❑ Boars
Number of Lagoons JE1 Subsurface Drains Present ❑ Lag—n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JCI No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes jjINo
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 DW'Q) ❑Yes ❑ No
c. II' 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 /No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes fi/No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Strt tur� I Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier: .........4.1................
Freeboard (inches):
5100 Continued on back

i'
Facility Number:ZA9 Date of inspection Printed on: 7/21/2000
5: Are there any immediate threats to the integrity of any of the structures observe ? (rees, seve
re erosion, ❑ Yes EINo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes .10 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 allo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ; VNO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes A(No
11. Is there evidence of over application? J❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type e, ;!�CJ��-
11 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 VNo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes ,�j 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 readily available? ❑ Yes ,d No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (iel 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 I/No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes N No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes 9 No
23. Did Reviewertinspector fail to discuss review/inspection with on -site representative'? ❑ Yes �[allo
24. Does facility require a follow-up visit by same agency? ❑ Yes 1 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? []Yes �JNo
�'S10 yioiations:o� deficiencies ►sere potea diWing this:visit'. • Yoi} :Will-reeeive iiq further
icorres orideik ab- A thi visit... ::... ... ::.:::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to_better explain situations. (use additional pages as necessary):
&orves G"z 7o e)y&oe,-S e e_i>
..
Reviewer/inspector Name n
14111 (�f*&l 5
Reviewer/Inspector Signature: - Date: 5100

Facility Number: — Date of inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor 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 dNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes .10No
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 VfNo
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 q(No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes M No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes VJ No
J
5/00

7-r
Division Of SOd and`•Water'COnservat,On _Operation Review
r
y r .'O.Division of Sail and _Water Conser`vation�;Compliance Inspection ' y x ;
bivision of Water Quality _Compliance Inspection s w
3 OOther Agency Operation Review-�
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-uE of DSWC review Q Other
E— Facility Number Date of Inspection �3
Time of Inspection I Cq 30 124 hr. (hh:mm)
Permitted O Certified �QO Conditionally Certified O Registered 113 Not Operational Date Last Operated:
FarmName: .. 0�► .1`..! �..... .......... ........................... County:......... ..... 1�.. 1...........-- ...............................
Owner Name: ................. ........ Phone No:..................
FacilityContact: ................................................................. .. Title:............................... ................ Phone No:
Mailing Address: .......... ..........................
Onsite Representative:..Q�!`n'!.......... Integrator:
kkAy-
---t—
Certified Operator:................................................................................................................ Operator Certification Number;..........................................
ca ' of Far
ar
�........... ... ..... 1 ...........4...::�............. x.............-...................�............ ....... ............ .
S
............
.....................
........... . ......... ............... t
Latitude • L .: Longitude • 4 «
- Design Current = Design Curretxt Design
Swine Capacity Po Mahon . PouEtry s Ca acity - Population,.- = Cattle -.Capacit.
Wean to Feeder
Op
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Soars
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
�Nauiher o€;Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
HoldingPonds'/Solid Traps �: ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Doles 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 CKNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes &No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .........3 �..... ...... .............................. ........I ..........................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes M No
seepage, etc.)
3123/99 Continued on back

Facility Number: 3 k — Date of Inspection 0
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancehmprovement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes No
9. Do any sluctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes W No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes O No
11. Is there evidence of Over application? ❑ Excessive Ponding ❑ PAN ❑ Yes "No
12. Crop type t S4
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 14No
b) Does the facility need a wettable acre determination? ❑ Yes j,@ 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
U�No
Re
uircd Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ZNo
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
KX No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Ky No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R' No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes to No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IV No
24. Does facility require a follow-up visit by same agency? ❑ Yes PNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes allo
Rio-violaiidns:or deficiencies •mere h6fed• during #bis:visiC • :Y:ou will -receive Rio further :
rorres ondence: abauk this .visit.
Comments: (refer Tto- question #) Explain any Y.ES answers audlai any'r`ecomrieiidations or,any otljer comments x
Use drawEngs of faeilrty to Fietter exp[aiii situations (us6:additional_pages;as necessaiy)
m
r) LSs;` � � ��vl� r V� ! � Q `� t^.QE-�► e1 l�Q i
s .Yet
Reviewer/Inspector Name 17
Reviewer/Inspector Signature: ---- Date: <-%g3 bri
3/23/99

Facility Number: Date of Inspection 73
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 Iack a submerged fill pipe or a permanent/temporary cover?
tion omrrtents an or iawings::
❑ Yes P�No
❑ Yes IN No
❑ Yes (�<No
❑ Yes UNo
❑ Yes gNo
❑ Yes No
❑ Yes [XNo
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
IM Division of Water Quality
Other
Date of Inspection LIolT
Facility Number 3 Time of Inspection J�O� ?d hr. (hh:mm)
E3 Registered 10 Certified E3 Applied for Permit 19 Permitted C
FarmName: ................. ..lfzc.txr..c......... Yaft...............................................
Owner Name: .............. Mtr t.......................
.........
�5�}................................................
Facility Contact: .....................1...............................................1.......... Title:..........................
Date Last Operated:
County: .........
Phone No: ...... Clio. ... 24fi. gow.......................................
Phone No:
MailingAddress:....... IQ....%% ...... §..r1.I.31�...............................................................................SSs Baku.V.itit-t.,......t.:.,C=..............................�� i q.........
Onsite Representative: ..... ....V.0 ....... Ls�............................................................._ Integrator: ......._L t tN�.........................................................
Certified Operator: ................ %h4n......r:.... ..... ........................................ Operator Certification Number .........................................
Location of Farm:
Latitude 0' 0' =11 Longitude =• =' ={I
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes [A No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated Flow in gaVmin? 0i !k
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any pan of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
[I Yes
No
5. Does any part of the waste management system (other than lagoons holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
'{ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Facility Number:
• 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons.Holding Ponds Flush Pits etc.
9.' Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 5
Identifier:
Freeboard (fr).............Z........... ........................................ ...............................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenancelimprovement?
OYes
❑ No
(If any of questions 9-I2 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
W No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
J@ No
(If in excess of WLMP, or runoff entering waters of the State, notify'DWQ)
15.
Crop type ............ a ....................... y............................... .................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
M No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
M No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
jR No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JA No
22.
Does record keeping need improvement?
RYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
P No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[A No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
V9 No
- No.violations-or. deficiencie-s.werenotedduring this,visit:- You.will receii�e-no-ftiritier'
: correspQn HO-e fi ouE this:visit-.: :. :.:.:.: ; :
U- cco-'iO" cw-e s ors `�" oJrtA— &6 ws.0 of YL, (CLvn a 'Ad Le }"Ij W'44, G�l %—
resze�e�. �a� art" 6�x ail+._ CjtjL S�atjo b2- MV �&Z • r } {
Z2, �r�Cos� �";(`r S�nouk� �� i� ry,� r"corc)S. (die in� (a ocl. �tVe is sko'jitl by r'_C '4e�
4 T W-11JIJ 'tw.- �rVlrl o.Qr'Ge� J sIvitJ 6e cJYau� h uO 4-
pv., 54t. J
Vrric�a�iur.++ acS��^ i�—
i �. ctr �i Cn.�1(Jn . �Cr
r-eGov>)�
t(�'y O� G'rt
�J-'
S��
has AOk �jee�- T1nS�a,�iccl� No
lY�SEotlia i'11�
condiRr,.,C', _oM4'�
7/25/97
Reviewer/Inspector Name tr'`x i�rx �,; A,.t
Y
Reviewer/Inspector Signature: Date: fo/�/qg