310667_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: ommpliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 04outine Q Complaint 0 Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: j al Arrival Time: $1.30 Departure Time: [gyp County: bo?Q�j Region: Q
Farm Name: L �,1dd:0- j--cz Owner Email:
Owner Name: vyJ f- tx 2 5 �✓- _ Phone: RFCEI�FLjAy,,,._
VxN
Mailing Address: R/DWR
Jbt
Physical Address: 0-dr
++ per QUali
Facility Contact: h t �l +y�-�cc.4d e•1rs C" Title: '[�rati6p. Regib,
r � S ag'ona/ pace
Onsite Representative: Integrator: ���
i�
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine
Capacity Pap.
et Poultry
Capacity
Pop.
C►attle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
ean to Feeder
Non -La er
DairyCalf
eder to Finish
DairyHeifer
rrow to Wean
Design
Current
D Cow
row to Feeder
I)1 PSoult F
Ca a_ci.
Po
Non-Dai
to Finish
La ers
Beef Stocker
!Farrow
lts
Non -Layers
Beef Feeder
ars
Pullets
Beef Brood Cow
Turke s
Pouets
her TOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑`No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
[:;]-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
�A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[fNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[r"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ff No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: 14 7UL
Waste Collection & Treatment
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�'i oo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
[3-NA
❑ NE
Structure I S/yttr7(uucttureJ2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �, 5 (- �J �} 7 L
b1�+��
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
ONE
(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
[EJ 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [D" Rio ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�o` ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, 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): C () J3
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EE No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[%f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[EI'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes dN0
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [ <0
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 6"No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Wacilfty Number: D - Date of Inspection: trU
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 [f 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 VNo
❑ NA , ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
]o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
El"No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
/�
[21
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L.=.1' No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
[ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ea No
❑ NA
❑ NE
omnieots (refer to .questtoo'#). E cplaW any YEanswers and/or any additional:reconiimettdations diany other comma©ts E 3
Use drawings of'facility to=better eplai©;situa#�o©s (usg,add�tioria[ pages
0 Je,
�3
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
�d-33 3
Phone: e�
Date: A pl `'�cw j
21412 dl5

� ivi"sion ofWater Resources
Facility Number � - �j p� O Division of Soil and Water Conservation
0 ww
Other AgeNcy
Type of Visit: omplrispection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: erRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t !c Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: i" L+'t 5� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: _ ) f
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
C►attle Capacity
DairyCow
C►urrent
Pop.
W to Feeder
Non -La er
DairyCalf
Seeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
top
Design Current
D F P�oultr, Ca_ aci Pio
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 1'oults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[/] N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
[] NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facifi Number: - Date of Inspection: ya
Waste Collection & Treatment
,L 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ef 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: 7-3s 1 '2- 3 SZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z S 3 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JdNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA [] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
m No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Vo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rN
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ 'Yesro
❑ 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

Facility Number: - Date of Inspection: ly,b
24 yDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Io ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes ❑ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ I'No ❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative? ❑ Yes [7'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yesrl"No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: I I Z 2_�_ ZI -6
21412015

� - i'vision of Water Resources
Faciiliiy Nurrtber N - ® 0 Didtsion of Soil rand Uater Conservation
Other Agency
Type of visit: Com nee Inspection 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: Q 4 j Arrival Time:' Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: PA r f I P fut4 e__
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: t 1 r
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
Layer
Design Current
Capacity Pop. Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
p
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
D , I;oultr
Layers
Ca acit P,o , Non -Dairy
Beef Stocker
Gilts
Boars
Other
Other
Non -La ers
Beef Feeder
I Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges andStreamImpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify 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 DNA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes
❑ No
❑ Yes
[ o
❑ Yes
Q-1O
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ins ection: j O
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Z 3 .5 / Z-3-S Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2) 2 S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rfN. ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesE]N'o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �3 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1V ❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectioa2o
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [] NA ❑ NE
Page 2 of 3 21412015 Continued

r
Facili Number: - Date of Ins ection: O �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 ❑ 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 [nNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes ❑ No DA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑"fo ❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ENo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? O Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
r-01/_ --AC < or-_(.3
(Re --. � C""_
/00 k q 00
1,e -(qc C- K,,� a C 4C_'-
Reviewer/Inspector Name: A " IC �/�
> �00C -0
Phone: ` ` n -7q
y
Reviewer/Inspector Signature:
Page 3 of 3
Date: 9 C2 / T
2141201 S

rype of Visit: V Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: LI,vt�A +S Ff4Q oA Owner Email:
Owner Name: F'1 �yN �� 1' Lt kcA S _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone:
Certified Operator: IN, L j P I >. spjyze( saSy
Back-up Operator:
Location of Farm:
Integrator:
0I S
ertification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I I
Wet Poultry
Layer I
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
I Dairy Cow
Wean to Feeder
M1 INon-Layer
I
jDairyCalf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul
Layers
Non -Layers
Pullets
Design
a acity
P,o
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
O#her
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes]
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: 31 - kal jDate of Inspection: )bjjj /
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 E] No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1��'}�11•,�7•�
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4( No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? 1A
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 No E] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �tNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
0 WUP ❑Checklists Q Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes0�
No
❑ NA
❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis E] Soil Analysis
❑ Waste Transfers
Q Weather
Code
Q Rainfall ❑ Stocking E] Crop Yield 0120 Minute Inspections 0 Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes P� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �No
C] NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: 31 1 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
P� No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JANo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
KNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Yes
OkNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ 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).
W.Pf • 1 a
6`9.1pq 1.64 O�L
-1 «IN
UQ1-4 6111
SLLAZ6� US a
L
Sol r
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: c))� �% -��6o
Date: o) Jl / V
21412014

Type of Visit: (:;Mompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: (ZRoutine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: O County: µ 1n Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: i� eY.
Phone:
Integrator: 11
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current Design Current
C►apacity Pop. Wet Poultry Capacity Pop.
ILayer IDairy
Cattle
Cow
Design Current
Capacity Pop,
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Design Current
i7 , P,oult , Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Other Turkey Poults
Other Other
Discharges and Stream ImnaCtS
1. Is any discharge observed from any part of the operation? [:]Yes W'No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes PTNo
❑ Yes krNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: '3 j -bLrj jDate of Inspection: t'li" 38'lS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �� L_pr^C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ b_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes Lj$To ❑ 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 4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes . �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes PrNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes PT�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1;;K0
❑ 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 'P?<o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes KNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,�!rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412011 Continued

r
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V No
.25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vj No
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 VfNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Uf No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
'INo
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31: Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNO
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
161
Reviewer/Inspector Signature: Date: 13
Page 3 of 3 21412011

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Iteason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 2] Arrival Time: Departure Time: L1S1=� 1 County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: �141 L-1 P L S 4,A/QG_RSCW
Phone:
Integrator•
a141 Q:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
1 Cil/f_3�
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
Dairy Cow
Design
Capacity
C•nrrent
Pop.
Wean to Feeder
Non -La er I
Daia Calf
Feeder to Finish
Daia Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . $o_ul Ga aci P,o ,
La ers
D Cow
Non -Dairy
Farrow to Finish
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
L
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 1� No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: ( - v Date of Inspection:
R
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYesto
❑ NA
❑ NEa.
If yes, is waste level into the structural freeboard?
❑ Yes o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: rfLoo-IT SA UC
Spillway?:
Designed Freeboard (in): R 5
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
X
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 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 VTNo
❑ NA
❑ NE
maintenance or improvement?
7
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J?l 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 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes . 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,, o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
r
❑ Yes No
❑ NA
❑ NE
the appropriate box.
o❑WUP ❑Checklists ❑Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard El Waste Analysis Q Soil Analysis ❑}i/aste T sfers ❑ Weather Code
no Rainfall [] Stocking Q Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Z, I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. i
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
� No
`
❑ NA
❑ NE
❑ YesXNo
���
ONA
❑ NE
❑ Yes ,j No
❑ Yes No
❑ Yes No
❑ Yes VVNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑YesfNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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).
i%7 c pu C:�j 9L3// OS
f
s
919&1/ 1 C" 9 1. c
Reviewer/Inspector Name: OM&A S Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

t DIVIsi-on of Wa`te Quality
Facility Number 3 1 - to iDO Division of Soil and Water Ganservatian
© Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: I& Routine O Complaint O Follow-up O Referral O Emergency p Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
L�
Farm Name: l /�[ Q� S F is q- t'l/t Owner Email:
1 (� q,a-53-�3gCogC++
Owner Name: is �N k,1 L{,cCAS 1 Phone: 910 -546 - 013&:� k3)
Mailing Address: ��iJ& lam) CU yC E c d 3
Physical Address:
Facility Contact:
Title: Phone:
OnsiteRepresentative: �N1LCI � N�rC3/V
Certified Operator: R t-41 C-L1Q 1J . 5.4A DCc %Sal%
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
X1I
Certification Number:
Certification Number:
Longitude:
I ./ S
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
C►apacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Dai Calf
X
Feeder to Finish
9a
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharzes 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
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: -0571 jDate of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -O&r �AGIL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lj �I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes iANo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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) VZ
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 4No ❑ 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): CA::!Qs�
13. Soil Type(s): A A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists 0 Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
0 Waste Application Weekly Freeboard 0 Waste Analysis Q Soil Analysis
❑ Waste Transfers
❑ Weather Code
0 Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections 0 Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Lo No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: 1 1 Date of Inspection: a jg—+j//
2; Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes _ T6 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes �No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
r
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 TZ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.=
Use drawings of facility to better explain situations (use additional pages as necessary).
� jq1io
"1
_AU B�'d�
l�l'a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9J6 - W43 94
Date:
21412011

Type of Visit —A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )6-Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /b Arrival Time: Departure Time: County: ILalAl Region:
Farm Name: L fl Owner Email:
G;1)9J0-533-rig &I
Owner Name: �\e-'Uq-uk,
Lquqs Phone:
Mailing Address: ' x� � � -- -l�aG� �`� � � � Lt Ala C%. 3 ��
Physical Address:
Facility Contact: Title:
Onsite Representative:� �y 1L1 t� SPA1M?_SC=w
Certified Operator: y N ILte �L SgNDB2SQ yi
Back-up Operator:
Location of Farm:
Phone No:
Irate Mrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 6 Longitude: = ° = 6
Design
C*urrent
Design
C►urrent
Design Current
Swine Capacity
Population Wet Poultry
Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
I
❑ Dairy Calf
CK Feeder to Finish 3 q
❑ Dairy Heifer
❑ Farrow to Wean D IPoultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish El Layers
El Beef Stocker
❑ Gilts Non -Layers
❑Beef Feeder
❑ Boars El Pullets
❑ Beef Brood Co
❑ Turke s
Other ❑Turke Pouets
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes
'gNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — (p Date of Inspection lb
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Q>ocic 'C
Spillway?: Designed Freeboard (in): '5),
�l •
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1*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?
❑ Yes ffi
No
ElYes ❑No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4 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
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [!]Evidence (ooff Wind Drift El Application Outside of Area
12. Crop type(s) __(fC3QW. Il00 e'T _ J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
P.
❑ 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
❑ NA
LNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'
❑ NA
❑ NE
Comments refer'to question ` Explain an YES6 answers and/or any recommendations or any othe ��
( .. q - ): p y r comments
Use drawings of facility tobetter explain situations. (use addEtaonal pages as pecessary): -B
T
ReviewerAns ector Name "� ` p /1!! /+��] (�%: Phone:
Reviewer/Inspector Signature:
Date: v
Page 2 of 3 12128104 Continued 1

Facifi •Number: ( — (�( Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ 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. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑baste Transfers ❑ ual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and V 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
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑'NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'04No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
[INEOther
Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'§�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1LI 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
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
tN
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
❑ NA
❑ NE
Additional Commentsand/or Drawings:
5 �10 � 3 9.3
w. N AS eeA'S� T AKE44 SST X-1 L-"a
puF_ gol\
Page 3 of 3 12128104

Type of Visit 35,Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 3!�Routlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 1 405 Departure Time: County: L i Region:
Farm Name: _ LA Alpa Owner Email:
n 910-S33-39Co� ti
Owner Name: 5 L 4 e Al P c t P • L LA-C.4S Phone: 910 -590 - 0436 6w
Mailing Address: M06YrCL��. 4aof �� u[ L-Ct4" d LA C
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �W Cg;�V - - - - Integrator:
Certif-led Operator: _ } j+ 1 L I P E -� A(Dep Sd& - - - - - Operator Certification Number: l �-
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0c 0, E] Longitude:
ign Current
Desqa
Capacity opulatiu
esign
Capacity
Current esign Curren
PopulationCap
;ECIWean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
Feeder to Finish Q
❑ Farrow to Wean Dry Poul ry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ ❑ Non -Layers
Gilts
❑ DairyHeifer
❑ D Cow
❑Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Cowl I
Number of Structures:
❑ Boars
❑ Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
El No
El NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ` � No ❑ NA [I NE
❑ Yes N. ❑ NA ❑ NE
12128104 Continued

Facility Number: j — (p(9`1-
Date of Inspection
Waste Collection & Treatment XNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes El No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?: {� C
Designed Freeboard (in): 19.5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No [INA [INE
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 /treat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �"No ❑ NA ❑ NE
maintenance or improvement? " 1
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 El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C 339/ "C-4 i SLAZEQ-NS
13.
Soil type(s) /V p M
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes P, No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes � No
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes 1�No
❑ NA
❑ NE
y y .* �� , !ions or any,other comments.
Comments `(refer to question #} Explain an YE.S answers and/or an r.,ecomm, I— . , _
addiiio©al a es as Qecessary)
Use drawings offacility to better- ex .,taut sttuahous: use ,
( P g.. a .. _
Reviewer/Inspector Name _ S' _ _ T�y_�.,� �',� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
lNo
[INA
[INE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
[] WUP El Checklists 0 Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑/nrival Certification
0 Rainfall ElStocking [DCrop Yield 0 120 Minute Inspections B Monthly and V
Rain Inspections E]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
i No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
,, \\
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�o
❑ NA
❑ NE
Additional,Comments audlor_Drawings
Stu1�� su2ur� �.tiv S3c�GniA 41= �09 -- QoN� � wA-I.rruG c,:v pApl�R�owC �
pw
9LI169
12128104

Division of Water Quality
Facility Number �p(Q�} Q Division of Soil and Water Conservation
- Other Agency
Type of Visit V
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: q' Arrival Time: I lel Departure Time: County: Ll ZY Region:
Farm Name:
Owner Email:
Owner Name: N e/V 9_UA 1 . --LAC Q S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: N t L NDER-ScW
Certified Operator: ` P +.� • SR�IDZS�1!
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 1 1/ _
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ 6 = Longitude: ❑ o = ' =
Design Current Design Current
F Sw�fle Ca act Po uiation uWet;Poultry , Ca aci Population
P P.. ty P.
❑ Wean to Finish IEJ Layer
❑ Wean to Feeder ❑ Non -Layer
® Feeder to Finish 14 gold —� - - - - -- —
❑ Farrow to Wean Dry Poultry
❑ Other
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current::
Cattle ;Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
9(No
❑ NA
❑ NE
12128104 Continued

facility umber-—_3) --
Date of Inspection EWTM
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 39 ( 3S 1
❑ Yes 4NO
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?: p
Designed Freeboard (in):
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes _kNo
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
❑ NA ❑ NE
❑ NA ❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
.X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or aay other. comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name IA11C Phone: G��(�' �ow!
Reviewer/Inspector Signature: Date: `1LI100
Page 2 of 3 12128104 Continued

is
Facility Number: 3 ( — Date of Inspection l D
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 4NO
❑ Yes d No
❑NA El NE
[I NA El NE
❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V 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?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 'PqNo
❑ Yes _NINo
❑ Yes 1(NO
❑ Yes _J� No
❑ Yes I�INo
❑ NA ❑ NE
El NA ❑NE
[I NA ❑NE
❑NA El NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes IgNo
❑ NA
❑ NE
❑ Yes A No
❑ NA
❑ NE
❑ Yes ,o No
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
Page 3 of 3 12128104

OrDivision of Water Quality /
Facility Number 0 Division of Soil and Water Conservation /
0 Other Agency
Type of Visit (D"Coompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (D houtine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f 2.tso Departure Time: County: Q!/PLLIUl�J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ?41!- - +�P St7N.t16a xd d
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o ❑ 1 ❑ „ Longitude: = 0 0 ` 0 ct
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
KI Feeder to Finish 11 7Q Z dW
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daity Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ElNA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes 0N'❑NA [I NE
�70
❑Yes❑ NA ❑ NE
12128104 Continued

f
Faci!py Number: — 1
Date of Inspection R o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 44;n ./ a15*1 LA &J 24,sL-
Spillway?:
Designed Freeboard (in):�y`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 21'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ETNO ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L/ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes 'ice No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes 91 o ❑ NA ❑ NE
maintenance/improvement? ,�,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes L"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
�No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E KNNo ❑ NA
[I NE
17. Does the facility lack adequate acreage for land application?
El yes
l�_I,NoEl NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Ejl w o ❑ 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):
U.) KEEP taP�' �� fo,�� fl►URc �j�J l✓�� �E�°CAI i
Reviewer/Inspector Name I T J ' Phone: Tla
Reviewer/]nspector Signature: - Date: `j v
rage a of j ta1t1iv4 [.ominuru

F
ility Number: 31— Date of Inspection
Required
19.
Records & Documents
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
N El NA
[I NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
;No❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box low.
V Yes
El No ❑ NA
❑ NE
El Waste Application ❑ Weekly Freeboard El 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?
El Yes
❑ NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
ElLd
,,,_, 'NNNoo
o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
< El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
7No❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No ❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o/❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
O ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
<o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes:No
❑ NA
❑ NE
(Additional Comments and/or Drawings:
12128104

Type of Visit �Co iance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I %d /a O drip Arrival Time: 3C3 Departure Time: � County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: - Title:
Onsite Representative: ?14 T— L, S
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = " Longitude: 0 ° "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apaeity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er I I
❑ Dairy Calf
RI Feeder to Finish
I cl % 9
'1
❑ Dairy Heifer
❑ Farrow to Wean
Dry poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
k
❑ Ture s
Other
❑ Turke Poults
❑ Other
10 Other I
Number of Structures
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
EjNo
❑ 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. Wbat is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
;40[1
NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

I
Facility Number: — 6b Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ Wur ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes E No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
3 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
E2"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L�" f No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElE Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0014
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3'NNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes B 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 Z No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ONo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo
El NA El NE
33. Does facility require a follow-up visit by same agency? El Yes ❑ NA ❑ NE
al Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number: 7 Date of Inspection
Waste Collection & Treatment
,_,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes P 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: I A fi tic d 9311 L!)b
Spillway?:
�+ t
Designed Freeboard (in): / / , ,J
Observed Freeboard (in): ] yl
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
ElYes V 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 ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R 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 I/ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind' Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EnNo ❑ NA ❑ NE
dNo ❑ NA ❑ NE
ZrNo ❑ NA ❑ NE
L'IN [I NA ❑NE
No ❑ NA ❑ A
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):
w aus ►� v►n�wCr . c A 6 �a a:� s ,� �s o E ass t..ra .1t
jC�c t° ���' c{ ►4 NN�ai,. C-�iLTS �S.CATZAN �lt.w— 6.%�t� l�[.of2.Qf,
Reviewer/inspector Name
Reviewer/Inspector Signature:
Phone: Via} !Yb
Date: _ !� / a 0
Page 2 of 3 12128104 Continued

Type of Visit Wcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Z Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: eparture Time: ���ounty: �/PL�i✓ Region: &,
Farm Name: Z�d✓ q'* IS Aee/ 1 Owner Email:
Owner Name: f/ae- S Phone:
Mailing Address:
Physical Address:
Facility Contact: ..�� Title: Akt,21.
Phone No``:
Onsite Representative: ZL ip62sor� Integrator: Soy. Ie5i�Rm
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: . Latitude: = o = g = S, Longitude: 0 ° = 6 = «
Design Current&
NMI
Design Current
Design Current
Swine
Capacity Papule„ton
WetPoultr,Y Capacity PRopulatioq�
a16 Capacftyopulation
❑ Wean to Finish
❑ Layet
T❑
❑ Dairy Cow
❑ Wean to Feeder
❑Nan -La er
Dairy Calf
ENTeeder to Finish
Q
iO d DO
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
El Stocker
❑ Gilts
❑Non -La Non -Layers
El
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
JEI Other
lumber of Structures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes PrNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
To
❑ NA
❑ NE
other than from a discharge?
,I
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Strut re I Structur 2 Z Structure 3 Structure 4
Frf�+t ?�51 �� 235 ,
Structure 5 Structure 6
Identifier:
Spillway?: Ma NO
Designed Freeboard (in): 4?.s
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes '0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes &No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;6 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;""No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Ely e s
�io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Reviewer/Inspector Name — r „ ��; Phoneiea
Q
Reviewer/Inspector Signature: Date: _'
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RfNo ❑ NA ❑ NE
the appropirate box.
❑ WIJP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
YfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
fi�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XN.
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
11 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
12128104

r
Type of Visit (3 Co pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility N ber Date of Visit: fo R at i Time: �a
O Not Operational Q Below Threshold
Permitted Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above reshold: ..... ....... ....------
Farm Name: �aJ9 R 3 d� Z ..... ......_......._
. ............ ........_....... r_...._ ' .......� . ..............._......... County: .......... _ ......_........
Owner Name: ................... _ ....... .. _...... _ ........... Phone No:
Mailing Address:
Facility Contact: __ ..1.' ..._ ...� .. .. .� . _yj..1�.,�T]itle:.._� - -- -- . _...._ /Phone No:-----
Onsite Representative: ,[!S( :]. � ..,�� b !' ' �..._ ..._.... .. Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • & «
E DeS1gA Current Design - Current' Destgn M Current
Swine m --ulaCattle ' _ace
au tPo Pouitry� Po
a 1 = Ca Po
elation. � citytaan �� : ulaflon
Wean to Feeder
❑F.
Layer ❑Dairy
[] Non -Layer W ❑ Non -Dairy
n
Feeder to Finish
� y �,
Farrow to Wean
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes E 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) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
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 [] No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway El Yes No
Structure 1 Structure 2 Structure 3 _ Structure 4 -Structure 5 Structure b
Identifier: �►LlL
Freeboard (inches): 31 LS
12112103 Continued

rFacility Number: �1 — �j '1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes�E�INNOseepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes
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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenantx�mprovement? El �N
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes l_7 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 7No
11. Is there evidence of over application? If yes, check the appropriate box below. El Yes
❑ Excessive Pondin G [] PAN ❑ Hydraulic Overload [I Frozen Ground ❑ Copper and/or Zinc
12. Crop type S W
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 VNN
b) Does the facility need a wettable acre determination? ❑ Yes [w to
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes ot
16. Is there a lack of adequate waste application equipment? ❑ Yes 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 40
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift durin95
g land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
:Comments {refer to -question ) E=pl - any-, answers and/or any: recommendation or_any omer comments.:" -- e
'Use drarvtngsepf faccdiiy to better ezplarn s tuatsoas.�(ase additional pages as necessary) F let d Cop ❑ Fir►al Notes
_. � y
_ , _s _
?, GMASS Couee— aO L4s6,o00J WALLS NEED SQME �MPat.oVEtME�
~
Fix. .D"-uj 'PsPE pin) LAG,000 f7eupyr.
JCNr AT 7jS-CR. ZS "1 DS to gE rsxCD.
HAY OEeos Ta Z,6 2CAA,0V (-9 err �FX6LA, ZxSLrA_ L! fxgt. D,
Ot.D
l So;N►E {nJ�IC.1C NL-EDS 'rfa R,6 Wa jt
AT 2SS€2
�c o fO :�wCo"a" M A364JA t✓ A WLZ CA Tzar►
tj
ro NAVb SRA P4gCARDJ AT �f12�►'! ,
MA► Sv+
�Lt' V) wQOzo�d xq
3s �tfs
Rev�ewer/Ins ector Name - M
Reviewer/inspector Signature: Date: ti 1 p
12112103 1 Continued

Facility Number: 3E — 4
Date of Inspection l
Required Records & Document~
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?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ SoiI 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?
NPDES 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?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required fo need improvement? If yes, check the appropriate box below.
❑ Stocking Form [I Crop Yield Form ]Rainfall ❑Inspection After I"Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes
❑ Yes �N/o
❑ Yes Rio
❑ Yes ❑'N
❑ Yes No
❑ Yes
El Yes 7N9,
El Yes � No
Yes ❑ No
El Yes
❑ Yes VN9
❑ Yes 7X0
❑ Ye [31�o
es ❑ No
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review LXLagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: a t7 Time: L
�,70
10 Not O erational 0 Below Threshold
0 Permitted © Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: /_ / j / r e Jn � I 2— County: DU r L 10
Owner Name: 14,ehr L4 L Lt cr, S Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
ine ❑ Poultry []Cattle []HorseLatitude 0 4 Du Longitude 0 4
Design .. Current
;awme ca2acity ro ulanon
❑ W to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current Design Current
Poultry; Ca acity- =Po ulatiop Cattle Capacity Pop ulation'
❑ Layer I ❑ Dairy
❑ Non -Layer I I El. 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
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. Does discharge bypass a lagoon system? (lf 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 ❑ No
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): t
05103101 Continued

r`
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need mainienance/improvement? ❑ Yes ❑ No
& Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13- Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [IYes ElNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Nail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ vNrUP, checklists, design. maps. etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soiI sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. rail to notify regional D���Q of emergency situations as required by General Permit?
(ie' discharge. freeboard problems. over application)
23. Did Reviewerdrispector fail to discuss review/inspection Aith on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
Cl Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
>; ::. �x, •. - YESsos�v .: dl � =rec = =ice
Gommeiits; refer to ttestaon ]am:aip ers,an o recomen s a nv:oiher comments
Use drawings of facility; to better explain situations. (use additionall pages as necessary) ❑ Field Copy ❑ Final Notes
®�.._ � - ..�::�: �.r:�tr_,_�.�._,�.�.:...�:"`� tom:-..z----•—,�..�..�--»�--�...,.M...�-.w_£��:�,
'levo
ell--
Re Co/y1r�1%llow� ` m4z9 C=� 4-0
ewer/Ins ector Name �x=h
.�,N_ h1 sR-r+-G�-r.1 . F. nrru y iif i , sY�•—+�Af ` 3 ���K r mEReAewer/Inspector
Signature: Date:
05103101
U
1 fCondnued

"tY___
I
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
(late of Visit:
Facility Number
Permitted ❑ Certifiied 13Con�dijtiio�nally Certified [] Registered
Farm Name: ���Q# S--
Owner Name: L�L�CfrS
Mailing Address:
Time:
Date Last Operated Above
Above Threshold:
Countv
Phone No:
Facility Contact: Title: - 1 Q Phone No:
� Onsite Representative: Gy1� A �, EKi 5011 integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude e 0 0" Longitude 0' 01 0�
Nnmleer of.Lagooas © ❑Subsurface Drains Present JUL.Keen Area ❑ 5 rav Field Area
Hoiding Ponds) Solid Traps ryrvQ _ ry ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 0 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. 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 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Z No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Z No
Swicture 1 S ture 2 Structure 3 Structure 4 Structure 5 Structure 6
- Identifier: / KO_/�� _ �'K
Freeboard (inches):
05103101 Continued

1
Facility Number: 3 — Date of Inspection —
5. Are there any immediate threats to the integrity of any of the structures observed`? (ie-/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10- Are there any buffers that need maintenance/improvement?
11. Is there evidence of oker application? ! ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Ovgload
12. Crop type ( 24/8Z � )52Cx / f/�t-
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 1jNo
❑ Yes V1 No
❑ Yes [�No
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes O No
U Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
IA No
Z No
0 No
;(No
PrNo
VNo
❑ Yes ZNo
❑ Yes Vj No
❑ Yes ,A No
❑ Yes Z1 No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes RrNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comaien#s.(refer to,'guest#an #) Eirplsie an_ y YES answvers and/o any recommerf bons or any other comments.
Use drawtn s of faciItty tobetter e�rphvn sttuat;aas (©se addthottal pages as necessary) 1 1 ote�-
S _ - . ❑Field Cony- ❑Fins
_ -
�IRGA S ° �'`'E!
F QE / � [�S,FS erfQ
110 6or ��c� Eo 7ia
.So�F 51 AJ
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility number: T — Date of Inspection l 1 U7J
dar 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?
❑ Yes ❑ No
❑ Yes [ \o
El Yes /9 No
❑ Yes Wf No
[--]Yes No
❑ Yes No
❑ Yes ❑ No
AdditioiiaI Gomtiieiits;and/or,Urawiaas: -
ln4iP
L/v7o/z
9,6z A Y'V'V4 �XG i! mmi.-5 )rat
zvOe-- S OfrG / �; 5l 47�Gt27 NIiT
OW,11-7 10
/v ✓ ��Y �%��/ 1�C�� c�l� Sly-
�� �O� Q��
/ /j��
/O
�f �ij%FG� �i4�lYi�f}`2f✓GQ.
�i f�'d.2,0 S
6i�
Y6� -
4,e 10/-&0)
05103101

vision of Water Quality
Q Division of Soil and -Water Conservation..
Q Other Agency,
Y
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit z1houtine O Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Date of Visit:
Facility Number3 t
,,aTermitted D Certified C] Conditionally Certified C] Registered
Farm Name: ........... ........:dq..'.s...... o,.r. ^.. ..1..il.� ............. . ......... ....
Owner Name: ff
Facility- Contact: .....
Mailing Address:
Title:
Time: F/2-5—T-1 Printed on: 7/21/2000
O Not Operational O Below Threshold
Date Last Operated or Above Threshold: .......................
County:.. D UyOI 1 ,
..............
Phone No:
Phone No:
Onsite Representative: ...................... I�a � er SO►'1 Integrator: -, V r�
7.................................................I..............-.........­­7 ......................
Certified Operator: O erator Certification Number:
p.................................................................................... p
Location of Farm:
wine ❑ Poultry © Cattle ❑ Horse Latitude C�• �� C�« Longitude �• �� 0°�
- - Design Current Design Current Design Current
Poultry CapacityCattle Population Ca d ..Po idatlon
Wean to Feeder I0 Layer ❑ Dairy
Feeder to Finish ' ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to FinishIL
Total Design Capacity
Gilts
n` Boats TotaISSLW
', Nttmlber of Lagoons' O Subsurface Drains Present Lagoon Area ❑ Spray Field Area
'$oMmg Ponds / SolzdTraps:: ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharee is observed. what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structur- 2 Structure 3 Structure 4 Structure 5
Identifier: �� en7At G�[
.. .......... ........-.....................................
Freeboard (inches): �� 3
5100
❑ Yes 'ONo
❑ Yeso
❑ Yes ON
o
4 Iq
❑ Yes ff No
❑ Yes No
ElYes �No
❑ Yes
,,ONO
Structure 6
Continued on back

Faciliiy Number: 3/ — Date of Inspection Printed on: 7/21/2000
101
5. Aie there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El YesZNo
(If any of questions 4-6 was answered yes, and the situation poses an /
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ;2'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [INo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level /
elevation markings? ❑ Yes QINo
Waste Application /
10_ Are there any buffers that need maintenance/improvement? ❑ Yes JYNo
11. Is there evidence of over application?
r ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [ONO
^+' 12. Crop type C e't , Lj kia cT) .SD 4 be Lt f 1 f /
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 'PINo
b) Does the facility need a wettable acre determination? ❑ Yes 9110
c) This facility is pended for a wettable acre determination? ❑ Yes [2,No
15. Does the receiving crop need improvement? ❑ Yes �No
16. Is there a lack of adequate waste application equipment? ❑ Yes J—ZrNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes El"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 ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes �ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ZoNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
(ie/ problems, over application)
,ffNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes IVNo
24. Does facility require a follow-up visit by same agency?
❑ Yes /0'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes � No
violaiiq>ns o. deficiencies were notes during �his:v. .... . ...............................
eceive i. lF..... .
ro" resj!6ndeRce. about this visit ...:.:.. . . . . .... .... . . . .
plain-a>ky YES answers °°and/or any=recoi
19. Tat ke wc,.OQ_ sAmP /es j uAr4e.r'1 Use L-jeo4o alp d of eJ a
�.Oe
-2No-fZ: Need 40 tlL�e la+, ,r�w�� J�r b�se�t on t.� e��d Acy-es,
Y
s0/'e. 41,iA4 Ga ul 1 {..�kpA4�,jo� bans,
",,,lure, er•e are �a cl ud CA
►uo-�-e � ree4 A -1a 9e" c ror r"I'0 `:0-L a b, i,4 - �o�SO on a c rea.o e
411 et J ^
Reviewer/Inspector Name S D✓1e�/ti�. ... �.5,.. 2�; .
Reviewer/Inspector Signature: Date: _S7 U671 5100

Facility Number: Date of Iuspection QJ Printed on. 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?.
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
zEfyes ❑ No
❑ Yes _0"No
❑ Yes_,EI'No
❑ Yes ,oNo
❑ Yes 12No
❑ Yes J'No
❑ Yes ❑ No
Additional omments an orDrawings:-
D�e�'cit14 re, well ke,O A.
5100

f
Slitvtsiion
of Water Quality °'
-� �'`
r
' 1Viston of $otI and"Water. Conservation
� O
r
Ft
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine
p Complaint Q Follow up Q Emergency Notification O Other
❑ Denied Access
Facility Number
Date of Visit: Time: Z b� Printed oar: 7/21/211t]0
Not O erati nal O Below Threshold
Permitted Certi ted 0 Conditiionally Certified 13 Registered Date Last Operate. Above( Threshold: ...
Farm Name: ............... t/.i...
L�_.L...Ir-,.lA.Lr� r County:............. ..................................
OwnerName:...........!%:...........................f�1r� . .�i..........._............................. Phone No:.......................................................................................
Facility Contact: ................................................... .....'True. Phone No:
MailingAddress:. .................. ...............__.................... -1- ......... ............................................... ..........................
Onsite Representative:. l �'LI % ,..................................................
............ ........' p............... ...........!� .UY Integrator: .irf�.✓.. .....
Certified Operator:......(./I%� Operator Certification Num r....l.n1...1..�................
...............
Location of Farm:
,WSwine ❑ Poultry ❑ Cattle ❑ horse Latitude Longitude �• C ` �«
Design Current
❑ Wean to Feeder
R�Fecder Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer JE3 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagm,n Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
b_ If discharge is observed. did it reach Water of the State:' (If yes, notify DWQ)
c_ If discharge is observed. what is the estimated flow in gathnin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ? Structure 4 Structure 5
Identifier: ..............
t l 3 tI
...............L_._._................--•-••--•- .--._...------..... _.__................. .._....... .............................
Freeboard (inches): 4 �/
5100 V
❑ Yes )(NO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ENo
❑ Yes 11 0
00
❑ Yes No
Structure 6
Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
1 '
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ANo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
�No
(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
)_grNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
]To
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
\
elevation markings?
❑ Yes
d�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evident of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop __.. -
g Animal Waste Management Plan (CAWMP)?
13. Do the receiving cropswith those des differ t designated in the Certified
❑Yes
�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
1 'No .
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
0
15. Does the receiving crop need improvement?
❑ Yes
)GO.
16_ Is there a lack of adequate waste application equipment?
❑ Yes
WO
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
;ice`°
1$_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
❑ Yes
KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N110
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
wo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [geNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes PJ�No
24. Does facility require a follow-up visit by same agency? ❑ Yes CWo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes t>No
0: Nd-viol'atidtis;or defciencies-v.-ere noted• during 4bis;visit' - Y:oft WHi-teeeive Rio fui-th& ;
corresQ©ride"e abb_f this visit. ... : .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any -other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
40
voul - s .
T
ti
Reviewer nspector Name
Reviewer/Inspector Signature: Date: 5100

FaciliO.Number: Date of Inspection Printed on: 7/21/2000
Odor Issues .
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or bielow
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover?
❑ Yes Alo
❑ Yes K1-1
0
❑ Yes 41,40
❑ Yes �No
❑ Yes o
❑ Yes :;0
jN67es ❑ No
Additional: Comments and/or �I-CGS—t Drawings:
WAS�I�h�tUL:.:._
kaA)w��(/��
�lo sk� �"tot
40
rLy moo^ 0�'�✓
ME
J
5100

© Division of Soil and Water Conservation - Operation Review
i; E3 Division of Soil and Water Conservation Compliance Inspection:
r Division of Water Quality - Compliance Inspection
Other Agency - Operation Review
jg1 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number -- (�(p'7 Date of Inspection {
—.-J Time of Inspection 24 hr. (hh:mm)
Permitted [3 Certified © Conditionally Certified E] Registered JE3 Not OperationalOperationall Date Last Operated:
Farmdame: ..........I ` ....... ...-...................................... Count:..... `...................---.......................................
t
OwnerDame:....... ....i`N............ ............... .......iIGL�S..j........................... Phone No: .... (316............-..................-.-...............................-...
FacilityContact: ....... 1... t.............................................................rTitle:.........---.................................................... Phone N�o:...........................................
Mailing address: .s? ... ...... *....... �t,... 10.: .... 1.VT.1k C4�C ............................. 2S.39'3
.... p..-. ` I ... .
Onsite Representative: .....l..klftq ..... ............................................... Integrator:......) 4...................................................
. sitir. ..
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
........................... D!.......e.�--O- .......... B.3-1T........r`►Ll...... Q�....a.......5......{.30.1...........................................................
......................................................................................................................................................................................................................................................................... F
Latitude Longitude �• �° �"
Design Current - Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I[] Dairy
Feeder to Finish ❑ Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean :.....',.
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity Q �R Z
❑ Gilts,
❑Boars -- - Total SSLW
lumber of Lagoons ® ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holdiiig Ponds / Solid Traps No Liquid Waste Management System
0_ ❑
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?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
e. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Rvtx6&c
Freeboard (inches): ...........�................ ..............Wit........----....
❑ Yes [BNo
❑ Yes P No
A-
❑ Yes j No
❑ Yes No
❑ Yes No
❑ Yes EP No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
ilPABIIM
[]Yes No
Continued on back

Facility Number: 31 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenahce/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste ADDllcation
10.
Are there'any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type w
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
]W 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?
fA Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
PO 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
® 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
P No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
19 Yes
ElNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
53 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Z3 No
23. Did Reviewer/Inspector fail to discuss reviewrinspection with on -site representative? ❑ Yes 0 No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
�: �10 yiQlatiEoris:or deficiencies -were noted• diWiog #his'visit- • Yo(tt :will-teceiye,io further
correspbide. . .abautthis visit.
�.g
Use drawings of faeiltty to better ezplamn situaboias (use addlttibnal pages -as necessary) N '
s6tA be OL84) k V11 WLP•
+ems � lea �•Yp ��at✓ �n�� a /gyp
�A qL �.?U � �.LF� "e an-� d 't-v� YY,� C. 'I` Dr. J)eE'jA ac Ve" e i rt OVS.
tvUP s y�,v1� b� t^� Secs ' rj 4 ✓f J �rri �a�i'or• des ��Y..
IA • (�?as,(-� r,�+�i,y s��5e SI�u�� �- c�da�a� , �c Waz�-e- ca-�Y s; S 5�oc�r) �e eb.�- oKre
Reviewer/Inspector Name
Reviewer/Inspector Signature: /__ Date: Aqy
3I23/99
r

Facility Number: 3 — (n� -} Date of Inspection �� Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [� No
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [� No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks Iack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional -Comments and/or- Drawings: r a as> 3.a
3/23/99

3 [3 Division of Soil and Water Conservation ❑ Other AgencyY Y
® Division of Water Quality
Routine O Com laint 0 Follow-up of DWQ inspection 0 Follow-u of DSWC review 0 Other
Date of Inspection ( 9�
Facility Number , Time of Inspection Zp 24 hr. (hh:mm)
© Registered d Certified © Applied for Permit IXPermitted 0 Nut O erational Date Last Operated:
Farm Name: ................ L-i4c,.�......ki rr,.......:�.'..I. � . ... County:.... ..11ik:4...............................................................
Z
Owner Name: ........ . ............
ame:.................•--........ t t(.................................................. Phone
FacilityContact: ........................................................................`...... Title:................................................................ Phone No:...................................................
Mailing Address: ......LDQ..... &K�.... ���.......ci A IfC`:1�,, �{..C�.....................................TifiC,�.y...
4-N.Cr....................................... . 443.1........
Onsite Representative:........: ...U(Aq....>[.!1�.�.��.p..... � Integrator: ...... lVl
) I
Certified Operator;.................................................................... Operator Certificatio Number:.......................
Location of Farm:
.... .....1 ... ...y.. .... s#... .e..,...�R:...t!riffs..... 5tt.,T..r,.v:.5Et...01 .............................. i
....... .................... ......-----............... .. ................
Latitude 0 '" Longitude • 6 "
10 Non -Dairy
General
i. Are there any buffers that need maintenance improvement? ❑ Yes [2 No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes. notify D)N'Q) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [0 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 [A No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes IS No
7/25/97

Facility Number. 3 — 11 -t
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes [;R No
Structures (Lagoonsfflolding fonds Flush Pits etc:
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
...[.a.................. ...............z
............... .................................... ........... I ................
.
Freeboard (ft): ..........."f.......................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
(A No
Structure 5 Structure 6
❑ Yes
No
❑ Yes
No
1A Yes
❑ No
Waste„ Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters off the State, notify DWQ)
15. Crop type .................UKP ..........ln] . ..........5.c t.1Q.ftv........................------............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for Iand application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes U) No
❑ Yes ;0 No
...................................................
0 Yes
01 No
❑ Yes
M No
❑ Yes
® No
❑ Yes
V9 No
❑ Yes
1) No
❑ Yes
29 No
IN Yes
❑ No
[3• No.violationsor. deficiencies' were•noted during this:visit.- Youmill t•eceivenoAirther :
: c0fres04ndeh6dhout this.visit:
❑ Yes ;] No
❑ Yes No
❑ Yes No
►Z• T,K � or. ��� 3CILe. �l � I�ga��
irzSooT.` S �j Sl\ou�� lbe- eiX�e_j. P904-e, k_ftwS an. boil,_ �„n�ooV,-- JUMP_ wtXs 5I Dv1d tom
�'�-�}c'tG.1'ttl, i 1 1 f ` -
L2. J� reCo��l S�pJ[0 st 1CtA� L S vi` YLi1+�1D2'r 4- �el 1itJTw rt Usi'`� {'L+L Car
CUKc�, X-ftY- ca�cl t� P,�il r�l 1 r a� lv� eh bla.ia.hce, A se ,Lmi� L
1 tOr C4t4., U-o Ce�r�.�-La�Tvr. t�6�1r. �G►r�3 ��ov�� 1 �]1{-�Y
Kw s, wassa U5 sOvlj S(pa&W
—A- Ve
@ aeti- lsale�s show' . ot" wee ��t � rY cr,r�ls. s%5Syu_ � a 7
ti.l V ��cJlci er sir., 7/2 /9
Reviewer/Inspector Name
Reviewer/Inspector Signature: , - / Date:

Facility Contact: I cuu.Lucim................................................... Title- .. Phone No:
Mailing Address: ZQQNc.�:_Hopc..Cbuxcb..Rd.............................................................. Turkey..B.0 ............................................................ Z8393 .............
Onsite Representative: Sw.U.J,1'IcLamb........................................................................... Integrator: ikliuMhy..)F:altillly..Farms......................................
Certified Operator: Philip.B................................. SAuLteraon ....................................... Operator Certification Number: .19.1.1.3.............................
Location of Farm:
pX ra tt ce.Q�n.lefit.......................................................................................................................................................................................................................................... .
Latitude 3S ' 03 17 " Longitude - 78 ' 08 25 66
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes X No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑,Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ©No
c- If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
[-]Yes ©No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
4. Were there any adverse impacts to the waters of the State other than from a -discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
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 umber: 3i:- 7
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holdina Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure
Identifier:
....................................
Freeboard (ft): .............2j7.............
Structure 2 Structure 3 Structure 4
.21 ................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
■ r5s M
[] Yes ® No
Structure 5 Structure 6
15. Crop type ..................... 5jQy.beans.................... ........................... Eoc'l :e...............
Milo, Qaty
16. Do the receiving crops differ with those designated in the Anima! Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Yes
® No
❑ Yes
® No
N Yes
[] No
❑ Yes
® No
❑ Yes
...........................................................
® No
I• No. Violations:or'dc%iertt:ies•wiv .r'e•r ote during this •visit.: Y-0ti vuiii.reeeive-no 'falr'ther'.'-
.......... ..... .. .. .............
correspoQ deuce' about ihis.vasiti• : ::. .
[] Yes ® No
© Yes ® No
© Yes ® No
❑ Yes N No
❑ Yes N No
[] Yes [R No
® Yes [] No
C] Yes X No
E► �®E©
[] Yes ® No
l 2) Need to vegetate bare areas of lagoon # 1 to stabilize against erosion. Should remove debris from lagoon as is possible.
22) Use IRR-1 fro each pull & IRR-2 for each field or IRR-2 for each pull. Balance nitrogen for each field and use WUP
-ecommendation N and rates.
24) Have technical specialist include application windows for crops. Also give tract # for leased land. Also need certification form for
Site 2. Need to have emergency action plan filled out. Have technical specialist assist in filling out odor, insect, and mortality checklists.
I 7/25/97 �--1
Reviewer/Inspector Name ioha Pilgcralsl Yertr+��a Cox
Reviewer/Inspector Signature: a Date:

• i
Routine 0 Complaint O Follow-up of DWQ ins ection O Follow-uR of DSWC review O Other
Facility Number
Date of Inspection if7
1
Time of Inspection Z : 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
13 Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: ..... ............. .._..... ..._..... .......... ...... .......__.......... .... ................... ...................
Farm Name:.vr��.11.i�� v~W"...'.�1..... s1 .r . Z.r�_..... ...... County:. ffbs1. �.1 L ....... _.... ......_....,.1_
Land Owner Name:.. 1ET� ^._.... �.�t :5..... .... .... Phone No: L l Q �... 5.az... .� j..
FacilityConctact:....._.... ..... ........ - ..... ._ ... Title: ........ .......... __..... ........... ......_.. Phone No:.................... _...._......................
.Z000 o� fa L` x. v rc.7�
Mailing Address: ..:__..�.._...�A.�,XI.....$. �... .........
Onsite Representative:.. . Integrator:
Certified Operator: ......... __..... ..,..., Operator Certification Number: _ ........._ ....__......
Location of Farm:
.Q�._�-oaa.�.�.t....� ` 4 ..__. .�..13. .....�.......�s.�.�..�7ct.��..►a�:xa. ............ ....�.. �+5.� �.tia.�i.�.:,C�_...... 4
..�....:ors.��.�s��:.i.�_.w.^.�!a....,�R.L3..�..1.��......�................�..------...._................_-......_------..._,......................�..-•-�----..._.................. �y.
Latitude Longitude �• lam` �'
Type of Operation and Design Capacity
$.tQe .. .... � �. Ca act � P.o u[ati:an � Poulir�;�. n_. Ca aci .'Po elation ,Age �Catt[e �H �, .Ca aca �Po ulat,on.w
❑ Wean to Feeder 3I❑ La r ❑ Da'
❑ Feeder to Finish ❑Non -La er [] Non -Dairy
' Farrow to Wean
,,.
Farrow to Feeder
Total Design Capacity n Farrow to Finish} F.._.
.,.,, m.
;� � 1`Total
Number of Lagoons /�Haldtng Ponds ❑ Subsurface Drains Present
❑
a xr Fes' Htt
❑Lagoon Area Spray Field Area
mw .
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes CR No
2. Is any discharge observed from any part of the operation? ❑ Yes IN No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IN No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes (@ No
c. If discharge is observed, what is the estimated flow in gal/min? IJ 14
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? J9 Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes RNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require JR Yes ❑ No
4/30/97 maintenance/improvement? Continued an back

r
Facility Number:..3.. —....fib..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (j,agoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
9.Yes
❑ No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
...�.._.�..._...... ....... .._ _ .. _ ......... ..... .............
......
...
10. Is seepage observed from any of the structures?
❑ Yes
91 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
® Yes
❑ No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
C9 No
Waste Application
I4. Is there physical evidence of over application?
19 Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type S
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
C9No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
IR Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
21No
20.
Does facility require a follow-up visit by same agency?
E[Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
For
Certified_ Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
J@ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
24.
Does record keeping need improvement?
2LYes
❑ No
Comments(refer to estion Ex lain an YES answers and/or an recomMendatio is or an other comments
i P Y a YK� Y� k .
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

1
Facility Number:. .] ... --.. .. Date of Inspection: g -1 141-1
Additional_-Comrrie'nts'"and/or Drawings
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A N o � t s
4/30/97

•
0
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: P ~ 9 , 1995
Time:
+��hr Lucas
Farm Name/Owner: L i e? �2' S �a r►Yl � _�
Mailing Address:
County:
Integrator.
On Site Representative: "
Physical Address/Location:
9r m on
33-- � I /Z M; G
ek
Phone:
_ Phone: 533- "ADa
o� _ iA+Cr . s2.1501
Type of Operation: Swine _�� Poultry Cattle
Design Capacity: 3 (02 Number of Animals on Site:Z-
DEM Certification Number: ACE DEM Certification dumber: ACNEW
Latirude: 35 ' O5' P• g2- Longitude: --2'3 ' 6�9 ' 2( 4f' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have saff cient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: & Ft. b Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Sbr No Is the cover crop adequate? e or No
C r
Crop(s) being utilized: the�n5 W�rr�c� r CO25fZ Y1 exf
Does the facility meet SCS minimum setback crnteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of liSUS Blue Line S�=? Y.:s or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by :pan -made dish, f ush_;ng system, or other
similar man-made devices? Yes or No I` Y ;-s. Please Explas,
Does the facility maintain adequate waste management .records (volurne-s of manure, land applied,
spray irrigated on specific acreage ridlt cover �., p}? Yes or No
Additional Comments: r - Q;M
Inspector Name Sign pure
cc: F;icihiv assessment Unit
Us,- Anachments if Nzeden-