470028_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

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Type of visit: 5 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Q Departure Time: ® County: �ak� Region:
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Farm Name: e (if/ti 1%e S fid - Owner Email:
Owner Name: &e4e { /, �elk_— l -, Phone:
Mailing Address:
Physical Address:
Facility Contact: Ca Ire lbw w "l Title: Phone:
Onsite Representative: Integrator: 0,k '
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Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
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Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes E09No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 1105I NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
IO Yes ❑ No n NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection: /7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 4 Structure 5
[;@No ❑NA ❑NE
❑ No Dj�NA ❑ NE
Structure 6
Observed Freeboard (in): Z �►t
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes ® No ❑ NA ❑ N E
(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 M 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 P 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 1� No ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes R;;KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or W lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cro Window ❑,/Evvidenccee of Wind Drift /❑� Application Outside of Approved Area
12. Crop Type(s): 602s _ tr'T"` g 9J' �r ( U����f
13. Soil Type(s): W91/J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
`i`" No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
W 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.
❑ 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
[j Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
F] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�j No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility }Number: ZI f2 - Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? IFyes, check ❑ Yes No
the appropriate box(es) below.
D Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [� No
If yes, contact a regional Air Quality representative immediately. TP
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 t] 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 [�3 No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
DNA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone: gl0'fJ'f 3 ?7�Oa
Date:
21412015

I
c N V Division of Water Quality
Facility Number - a Division of Soil and Water Conservation
Q Other Agency
type of Visit: 4D Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Departure Time: p;a0 County:
Farm Name: Lh w $ G Owner Email:
Owner Name: ya� t res t _ Phone:
Mailing Address:
Physical Address:
Facility Contact: n e rori - f.J►'1 Title:
Onsite Representative:
Certified Operator: tt
Back-up Operator:
Phone:
Region:
integrator: Si,,&J Co e l
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
�W Z Al, p ,C
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Discharees and Stream Impacts
Design Current
Wet Poultry Capacity Pop,
Layer
Non -La er
Design Current
Pou
Non-L,
Pullets
Pou
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? 0 Yes T � No ❑ NA ❑ NE
Discharge originated at: [3Structure ❑ 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 F NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
['] NE
❑ Yes
}p No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Co NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Il
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g t�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
fp 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
N1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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): rws4ol
13. Soil Type(s):
14. Do the receiving crops ffer 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
[P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CD 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 P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes W No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T4 No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
21412011 Continued

' Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J@ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
[:]Yes P No ❑ NA ❑ NE
❑ Yes P No ❑ NA D NE
❑ Yes L?GNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
0 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 T No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other corn ments.
'-
Use draWings of facility to better explain situations (use..additianal pages as necessary).
fo6yj i'`lav'blC
(ell) 910-62-N-N6d1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 11,9 5-UL),
3349
Date: Il 30
21412011

�1MS UVS a131113 _
Divas --ion of Water @iex�ity' '�$}. p�
Facility Number ©- ® '0 Divisl and Water Conservat ion of Soiion
Q Other Agency
Type of Visit: (BrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other r'0 Denied Access
Date of Visit: El Arrival Time: 4�/►, Departure Time: County: rl Region: �� n
Farm Name: RQffi2d _ Liy'oSur( Foor, , 1=-G , Owner Email:
Owner Name: Rae&j LI %,orfpr_k rj21m S Phone:
Mailing Address:
Physical Address:
J y
Facility Contact: Ll m BLQW Title: w, ,L Phone:
Onsite Representative: Cm Integrator: �f_B
Certified Operator: ( AM 19-nA �%tryy�/� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
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)?
Longitude:
❑ Yes 5 No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes n 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 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 q
-"%-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [5kNo
❑ 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 tR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo
❑ 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): aw yl
Y
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
® No
❑ NA
❑ Yes
CR No
❑ NA
❑ Yes
C@ No
❑ NA
❑ Yes
® No
❑ NA
❑ Yes ® No ❑ NA
❑ Yes No ❑ NA
❑ Yes No ❑ NA
❑ WUP [:]Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. "--'Yes ❑ No
❑ Waste Application 21 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
[DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
0 NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ 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
2 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
fR 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
U 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
JZ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriattJyj.below.
❑ Yes
Rj No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ® Other: VM
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
g, No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
Comments (refer twquestion#): Explain Any YES answers and/or any additional recommendations or,any.other comments+
w« 4 *
Use drawingiIU-facility. to better explain sEttiati©ns (use:additional pages as necessary).
Is, FjeUr w?(-L II tj -� it s f1), i �l�a���.
31. Qlepae recov� )a
'fao, Pei'. i WPe4 i
7, PleAse. Cho orpoj'sc� pokwpq Q f,,. ,) t�
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
;ns�de_ban kf &� r�f 00)
i J&ai h Pier Phone: qj0_ (1CCr
Date: Let 111)0 n
21412011

Facility No.Farm Name O Date of
Permit COC OIC� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
ghzlix 1P;asbonlf rv',amN&11—
FB Drops
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
34
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
WPffl 1. o'A T ida IMAM
EMS • . ..
► M1.
����--Actual
-
Flow
Design
Soil Test Date �[ Crop Yield Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed ? WUP �_ Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu-I Zn-I 1 in Inspections Check Lists
Needs S (S-1<25) 120 min Inso. Storm Water
Needs- WeatWill
her Codes
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
Q
aI
ioaa
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon # App. Hafrdware Top Dike �' j
Stop Pump ,y
Stark PumK,( is rr
Conversion- Cu-1 3000= 108 Ib/ac; Zn-1 3000= 213 Iblac
i, -7

is
for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: at4 L. G fL-- Owner Email:
Owner Name: RiO�Q &Vq.5 L 1'C � w—S �t4 Phone:
Mailing Address:
Physical Address:
Facility Contact: 60 111 1;,1 Title:
Onsite Representative: H
Certified Operator:
11
Phone:
Integrator: JpI1A'Wi
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: Fi12-Q
.Desi�nGurrent
F
ED,sign Current
DesignPop.
Poultrypacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
DairyCow
'
Wean to Feeder
2
jj[RWet
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dt. P,oult ,
Ca aci
Po
Non -Dairy
Farrow to Finish
a
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[-]Yes
No
T
❑ 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
LPI� NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

' Facili. Number: Lf `J - Date of Inspection: /" 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
[:NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V514
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.)
T
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'?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
T
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 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable C/rop� Window ❑ Evidence of Wirld Drift [] Application Outside of Approved Area
12. Crop Types):
13. Soil Type(s): !2jt'ZU-\ ..
L/
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
T�
❑ 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
F3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[PNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1p No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�q 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 rVI'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �p No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

jFacility Number: !f 7 - 21 1 1Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �g No [DNA ❑ 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 [pe No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �2 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes FM No ❑ NA ❑ NE
and report mortality rates that were higher than normal? TT
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 V9 No
❑ Yes [� No
❑ Yes t No
[] NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes F No ❑ NA ❑ NE
33. Did the Rev iewer/[nspector fail to discuss review/inspection with an on -site representative? ❑ Yes N] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes n 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).
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonc:
Date: 1' y
21412011

I�
• Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
f ype of visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
2eason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l l Arrival Time: D' Departure Time: f Q County: b
Farm Name:Owner Email:
Owner Name: -�^8-r� 1' w_5±7('r- L +r M S '-pue, Phone:
Mailing Address:
Physical Address:
Facility Contact: &ime-roin Title:
Onsite Representative: 4i
u
Certified Operator:
Phone:
Region:
Integrator: /4L4-RJj,r0loWn
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede;
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
9Sa OD Non -Layer
Non-L,
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
. 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 49 No ❑ NA ❑ NE
[:]Yes
[:]No
M NA
❑ NE
❑ Yes
❑ No
1P NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1f, NA ❑ NE
Strums Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?;
Designed Freeboard (in):
pi
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EQ 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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Qg 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 ff ��D EviZ
e of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): QU� UVrw+,�[�% l9-'!>2 � m
f
13. Soil TYpe(s): Own vh -tjj
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T�] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
LP
❑ 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 [)9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EP 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. Ep Yes [:]No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis [Soil Analysis ❑ aste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection: iopk 3
1111
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
79 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ 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
EP
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)
E`
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes qg No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [9 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).
( � Cv rt
�`�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910-133 "3300
Date: (e Whl
21412011

0 It
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Other
�
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint O Follow up 0 Referral O Emergency O Other ElDenied Access
Date of Visit: Arrival Timer �d� Departure Time: County: 0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
KN�S 1, Owner Email:
Facility Contact: t--l.(1meroq Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Phone:
Phone No•
Integrator: _Mr-b-06L)t&
Operator Certification Number:
Back-up Certification dumber:
Latitude: = 0 0 I = 11
Longitude: ❑ ° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
D4� I❑ Layer
❑ Non -Layer
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Pouets
❑ Other
Discharses &Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑Structure ❑Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Caw
❑
Dai Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Stale
other than from a discharge?
J
❑ Yes N No ❑ NA ❑ NE
❑ Yes [:]No P NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No I�NA
❑ NE
❑ Yes P No ❑ NA
❑ NE
❑ Yes CE�No ❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through. a waste management or closure plan?
❑ Yes C}No ❑ NA ❑ NE
❑ Yes ❑ No [RNA ❑ NE
Structure 5 Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes PNo ❑ 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 EpNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q�PlNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ( No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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 Area
&
12. Crop type(s) J'Z �1 1 �. _ a-,, `� ow"Ca
13. Soil type(s) J�aGiyL7 ,•� +'i AAA
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
E�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ER No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
FNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA
❑ NE
W.
p, ren( .: qx)�Yy oy othercamCopmLrefer�to ueshott # Ex lam an YES answers and/or an recommendations or tt-.y- t.fl"S-Sh+':r. -�
Use drawin sof fttcili. to':bctter cx lainsituations: usc:additionaltpages as ne.cessa . 1
k ,d P y� y( P i t'Y), q
iBtl i$tlr M1R '7t1 6Y 4 e K�ri'i?� at.l4i�l?1f.fl�r'-..:�.. yN �l �f �.:y!MJ AI ? NkA. ,T I ..: •.. p .-I '.Y k..k A' i�:�? � J �i:".,I� I JSYI','d fR#il:
4&
f
Reviewer/Inspector Name �'p�,,µi. Phone: %p._ �r�33DQ
.r,
Reviewer/Inspector Signature: Date: &
Page 2 of 3 11118/04 Continued

Facility Number: _ Date of Inspection BUJ
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JoNo ❑ 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 I ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [§ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IRNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
pa No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(8 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
f
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
Wo
❑ 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Ejj No
❑ NA
❑ NE
AdditI` Camments,an'd/or Drawings.'ry'
Page 3 of 3 12128104

Division of Water Quality
jjj=EaaC1i=t1i1ty1 �— Division of Sail and Water Conservation
�—�---- Q Othcr Agency
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitt *Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �.`ODc� Departure Time: County: Region:
Farm Name: P-L tl�-t -n � W-4yc-t'-� i�MS . � Owner Email:
/``-c-T& Owner Name: r��u-Q�� It,w��e Phone:
Mailing Address:
Physical Address: yy��__ ,,,-- ,,
Facility Contact: � "Q.►►�P.iqdV\ -I�' K Title:
Onsite Representative: N
Certified Operator:
Back-up Operator:
t~
Phone No:
Integrator: ���i�wo , (-LC
Operator Certification Number: 742
Back-up Certification Number:
Location of Farm: Latitude: = e = 0 Longitude: 0 0 = i = {1
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design C*urrent
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
91 Wean to Feeder 3SSA
3 J-00
10 Non -Layer I
I
Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
La
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts. -
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cowl
I
❑ Turkeys
Other
❑ Other
Number of Structures:
❑ Turkey Poults
❑ Other
Discharges A Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[)�NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
M 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
�5 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
QNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: � Date of Inspection 7 2?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
1pyes
❑ No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .214 it
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 [INA
❑ 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 *�3 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes 5 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 Jj5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [!A No [DNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C nft, 'ill Fk4v& fJ a Q✓thl5_ -tQ -1
13. Soil type(s)
v
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
fig No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
§9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
.Comments (refer.to question#): Explain any.YES answers and/or any recommendations or any other comments ,s, s
Jse drawings of facility to better explatn,situations ;(use addition a[ pages as necessary): i
a,,`rf�
Reviewer/inspector Name 1 Phone: 9f0�&30U
Reviewer/Inspector Signature: Date: oi'7 p9
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Re uired 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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EP No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
KINo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;9 No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V9 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
[I NA
El 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
Id No
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V] No
❑ NA
❑ NE
Additiongl;Comments and/or Drawings;
OZ
w
Page 3 of 3 12128104

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ElNE
a. If yes, is waste level into the structural freeboard? ElYes I No PNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ERNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 5No ❑ 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 JpNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �LNo ❑ 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 QI'No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes $ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
MEMEMMMMER.K4 MIN
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
T No
[__1 NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V1 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name Phone: 9
Reviewer/[nspector Signature: Date: iLOB
1aic0iv1# f.urt[rnueu

L4rl
Facility Number: —� Date of Inspection .2'1
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 appropirate box.
❑ WUP El Checklists ❑Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7INo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Kn No [INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
lj� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ 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
fp 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
$j 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
$1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

® Division of Water Quality
Facility Number _ J oZ O Division of Soil and Water Conservation
-. 0 Other Agency
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: "loll"
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: � DO Departure Time: 10: S ry, County:
t/"*�`e sr•►aS Owner Email:
Physical Address:
Facility Contact: CGti h1 L'i� 8k7? w ►) Title:
Onsite Representative: it
Certified Operator:
Back-up Operator:
Location of Farm:
Phone -
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: Aloev
Latitude: 00 =, = Longitude: 00 =I =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population, Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder
3 0)4
39%C O
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer_
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ,® No ❑ NA ❑ NE
❑ Yes
❑ No
R1 NA
❑ NE
❑ Yes
❑ No
�9NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
12128104 Continued

i..,
FacilityNumber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2711
❑ Yes q No ❑ NA ❑ NE
❑ Yes ❑ No �K NA ❑ NE
Structure 5 Structure 6
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 [a 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 IR No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�K 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/improvement?
It. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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) i4 6;1?55
13, Soil type(s) MJl\"
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
(2 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® 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
W No
❑ NA ❑ NE
;Comments`r;(refe'r toiquestion #) Explain any YES.answers and/or any recommendations ar any other comments
se,,drawin s;of faciL to better ez lam s> nations._ use i3ddtttonal a es as necessar }
{y� g tY p ( -pages Y:„ ��..
AL
Reviewer/Inspector Name
Phone:
Reviewer/inspector Signature:
Date:
Pa3,+e 2 of3 112128104 Continued

c 'a
Facility 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 0 Checklists ❑ Design❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Pa No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[5d'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
21 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
nNo
❑ 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
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance ofthe permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® 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
J4 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit t-Com lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit drRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: • d Departure Time: County: Region: 9zo
Farm Name: U r !n Owner Email
Owner Name:
Mailing Address:
Physical Address:
e—A,,1
f 1 C Phone:
Facility Contact: reWrl Title: Phone No:
Onsite Representative: Integrator: �J! `I
I &dw
Certified Operator:00-1f1'6Y1 r 6UM Operator Certification umber: / 76
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = 6 =14 Longitude: = ° = 6 = �,
Design
Swine Capacity
Current Design
Population Wet Poultry Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
can to Feeder
$$
0
❑Non -La er
❑ Feeder to Finish
❑ Farrow to Wean
Dry .Poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Beef Stocker
El Feeder
❑ Beef Brood Cow
❑ Boars
Other
Eff Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes to
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
Z�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
UPNA
❑ 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
—0i NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes *o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes *o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — ff Date of Inspection /7
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 jQ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I {
Observed Freeboard (in): sit
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes *,No ❑ NA ❑ NE
(iel 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JKNo ❑ 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 ko ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application`? Ifyes, check the appropriate box below. ❑ Yes
lo El 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
t❑ Application Outside of Area
p type(s) a
12. Crop e _ &—y-M _ t� f �.1,j/)' X� (;, -,
13. Soil type(s)
14. Do the receiving crops dil`i from those designated in the CAWMP?
❑ Yes Ao
❑ 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 V1 No
[I NA
El NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes J&o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes *jZLNo
❑ NA
❑ NE
aComments (refer to `question #) !Explain any YES answers and/or any recommendations or any other: comments
r:r4c{A lit +. 3;
Use d'rawrngs of facility to befter explain situations. (use additional.pages.es necessary):''
t.(,e/s��
Reviewer/Inspector Name lk�k /°%).G;t�X4VI Phone: [phone]VC�
Reviewer/Inspector Signature: Date: , 221.14ZJ00L
Page 2 of 3 12/28/ Continued

Facility Number: —b Date of Inspection / O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes
>Iqo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes"VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge`?
❑ Yes
JNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
VA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
J§tftA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes -Jirqo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
-No
• ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Nj�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
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
kNo
❑ 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
o
to
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency`?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawin"gs:
NO(E S LU dS e S uf
o-vi l
�
re e-1
PP__t ✓ ►r-ed
P r; oY
40
101 I e>
Page 3 of 3 12128104

Facility Number OR Date Time IN Out______
Owner �vew JQ�E
u
Farm Name V�S�o r-a.
0.I.Ct`YL6kS�'1 No.
ti
C.O.C. eneral NPDS
Dest Current Desi Current
Wean to Finish
Feeder to Finish Farrow to Wean
Farrow to Feeder . Farrow to Finish
Gilts Boars
Other
Soil types
Crop Types (,{ - ILY% Pan cX Window
a
Soil Test Plat —�---�
Designed Freeboard Observed Freeboard
t Rain gauge Rain breaker
� �
Calibration of spray equipment
Sludge Survey Crop Yield,
sh - gl3o
z r )
Daily Rainfall Waste Transfers
G.P.M.
120 Minute inspect' n
1 in. Rain inspect' s ' Bather code ram/ Weekly Freeboard
Pumping time
,,,,-Taste Analysis % & Month Yip
1I .� 0'/,7 _ ): o
Comments
� U {/
1. a--

Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit QkRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number hate 01" Visit: �—D J Time: Z f •4
10 Not O erational 0 Below Threshold
© Permitted [] Certified /Conditionally
/Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: kit r' i ��•�%i[ i Y/.4T K TAy[ fh L County: `r.' K r V
Owner Name: _ J��&ka i( p p Phone No: f/O
Mailing Address: ! D aic t S 5�� d r ,3y rdN_C_ &S 3+
Facility Contact:
Title:
Onsite Representative: 1 ntegrator:
Certified Operator:
Location of Farm:
Phone No:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0" Longitude 0' •
N„ ,,, , l Current
Design iCurrent ,, '3l�3ir, 1,� 3'1i{s{.a `,'Design , „i Current r j �j;, Design ¢tE,
, �.��i �! { 1 t {,.: yr l?. , "t�, , �. i3
Swine.��;� '��; Ca acit��``:fPo'ulation'�!;""„3;,IP.oult '„�!!_.,�"!;�lCa''acitv.;:Po ulatton'I�..,Cattic 'R;'�',��i11Ciii acitvId, ulatiant`'
&Mean to Feeder ❑ Layer
❑ Dairy
l�
< j ❑ Feeder to Finish {; ❑ Non -Laver ❑ Non -Dairy
❑Farrow to Wean ,
❑ Farrow to Feeder ;`' ❑ Other
❑ Farrow to Finish
' � , � Total Design Capacity
❑ Gilts
❑ Boars �, , F: Total SSLW
E 1Number6f Lagoons; s E i' { Q1i 1i,1Il i, `,I Subsurface Drains Present ❑ La oon Area S ra. Feld tj
4�,�[ii
1iciiding'Ponds`/,SoI1d:Trapstht "',r� ;;�i;F11! No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes � No
Discharge originated at: ❑ Lagoon ❑ Sprav 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 ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
NVaste 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:
! 1
Freeboard (inches):
05103101 Continued

Facility Number: 411 — 8- 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 ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance!improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ 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
I6. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor ].~sues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
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.
..... su lk.ar nr."-as+.+-jMM"% rsEivan; -;cS:s G" ^ urs:-r.r-'v;Suauiul!'...,.._._4 :'su::tr:grimal « .::'•+l rr.:. Wu:c:"I•+r<uSn:r: :ui"'cn ,�si:,aEr� -°xr r�w....yst5nr; r.:r°a7ze •,yi vie +ii
Cammeats {ire[erita,gon}.fExplain a:tyYES answersd/aranyr+ecamnnendafio� orgy/otlt<er.aamments5r13,},t: ,�
y" a f C" L1°SEF-G ' +,d['i'& lip :. �is-Z h+ ""U5 xh:.'N!� !!;" fl'+nr h °IIIlu81 L41L.siii}Mt - '�iiitiit' "�'w i f 1l,1 _IiStl71N11iiNglS'.Cw:-" �t� �'t�w-w.z.. _.,,w_.: ,w..w.:,.�....,.. ..-3s i�
Use dravriQgs oflty�to'lbettes eat sit�iations'{e'additiona)l3pagn, as wry) „, � ❑ Wield Copy ❑ Final Notes
1 L i� 1 if ry' li SOME
f i i i i i
�► i'; ;a i� �# � �1� �1SOME EH ��> `���G9 +11. '�.ii�a-��1�""��i ' � �r+r� ��.I�a%�
rsx s ��F�}}tt?��y �I" 1tPf��1�^l� � . �� � �� j1 '"��" � ' il'� ' � °i 1! , h�� I, r
Reviewerlittspector Name uii p��.'u':i %r !ill4 ..z4' d t . ' r l trr",'I1; h�1Y�iI iA i $ii'���Jill;��� u �� a�if �r.i ' iyl�i
Reviewer/Inspector Signature: Date:
12112103 Condnued

Date of Visit: Time: .Zi�
Facility, Number
I
IQ Not O erational 0 Below Threshold
® Permitted ® Certified
0 Conditionally Certified C3 Registered Date Last Operated or Above Threshold:
Farm Name: _ AA,-4,,
A Lore sC tJ, t-l�1`.,n 1►nC County:
Owner Name: _/, e-&LI
l.,e&es!Lx Phone No:
Mailing Address: 2.1).
Q,,, K !E C 9 G. 22_9 G
Facility Contact: __ Lta��{
b, >3 rr�L,_� Title: Phone No:
Onsite Representative: e./.,N.¢1"ou-
Vim t.,=- Integrator: Le fit blL S
Certified Operator: Ca
rC9 r-zy lti QCbL--r2- Operator Certification Number:
Location of Farm:
OlSWine ❑ Poultry []Cattle ❑ Horse Latitude 0• 4 " Longitude 0• �• 0 K
Design Current
Design Current Design Current
Swine Ca acitV Population
Poultry
Capacity Population Cattle Ca acih, Population
❑ Wean to Feeder
❑ Laver
I
1
10 Dairy
® Feeder to Finish
❑ Non -Laver
I
1
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
I Number of Lagoons L 6 1 1L_! Subsurface Drains Present I1LJ Lagoon Area 1LJ Spray Field area I
Holding Ponds / Solid Traps ❑ No Liquid Waste Mana ernent System
Discharbes 8 Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __
Freeboard (inches): �LAL
05103101
❑ Yes ® No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes No
[I Yes No
❑ Yes [�] No
Structure 6
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes {l� 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 yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ®•No
Waste Ap licp ation
10, Are there any buffers that need maintenance/improvement? ❑ Yes Win
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type Q e f on l,, ala— i- Si,G-r,. O' o "S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes Eg'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
E] No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[5]No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
qNo
24,
Does facility require a follow-up visit by same agency?
❑ Yes
C-No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ES No
No violations or deficiencies were noted during; this visit. You will receive no further correspondence about this visit.
" w� �°
question;#) Expiain anyYES ansiwers, andlor any recomrnenrlatitins;�nr uny other' °commt Comments (refer to.
s Ar W Ii
a
p.�uu
s.
ty p es as necesear
[Jae raw s'of facili to tiettertiex lain situatlons. use additional ❑ Field C Final Notes
€ pr g n y)..
�t1 VE t0 � ,., ,�ri , � y�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
O5103101 1 Y Continued

Facility Number: Date of inspection O
Odnr Issues
26. hoes 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?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 9 No
❑ Yes (3-No
❑ Yes OJNo
❑ Yes ES No
❑ Yes �5No
❑ Yes ❑ No
05103101

State of North Carolina
Department of Environment,
Heaith and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
DIVISION OF WATER QUALITY
April 2, 1997
Mr. L. M. Upchurch, Jr.
P.O. Box 440
Raeford, NC 28376
SUBJECT: Annual Compliance Inspection
Raeford Livestock Swine Farm
Registration No. 47-28
Hoke County
Dear Mr. Upchurch:
On April 1, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facility. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facility was in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management -plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 486-
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
John Ray - Hoke Co. NRCS
Wachovla Buildings, Suite 714, Fayetteville FAX [phone]
North Carolina 28301-5043 N19 C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 5096 recycled/10% post -consumer paper

Routine -0 Complaint 0 Follow-up of DW2 inseewon 0 Follow-up of DSWC review 0 Other
FAcft Number2 Date of Inspection 1911TY
I TlmeoFbspecdon - Z : � Uwuhr.thoe
Farm Status: Total 71me (in boon) Spent ouReview
or Inspection (includes travel and processing)
Farm Name: County:
owner Name: &j6jL-wZ Z tg&2 �apa 29te awc &—Io) I?U---
Phone No: 3 UOK
Malling Address:?. Y6
Onsite Representative: - Le4; d2 D".a Integrator. 6ifeel-1-7,
Certified Operator. &C,4A 2- Q .1 firm
r XZ -- — I Operator Caffleation Number.
Location of Farm:
lAdtode 0 6 a Longitude 0 4 U
0 Not 02erstdonal j Date Last Operated:
Type of Operation sod Design Capacity
'N W LAY �71124;�1�111�,;,�,
-Y 4. g wo 41
Wean n to Feeder I T r, I
Feeder to Finish Nor,
Eamw to RLM
EMw— IQ hdaF""' _ ..t',Y.'..J�IL,x. r t .. �i } Sr ;;ia?"T. iz'.'�„ �a.
FarrawAo-Finish Other Tpe of Livestock
Subsurface Drains Present F3
Ugcues Ara j Spray Field Area a
P�
fialow
1. An then any buffers the need maiatene
2. Is any &wlwge observed from my part of the operation?
L If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'! (If YM no* DWQ)
c. If discharge is observed, what is the estimated Dow in plfmk?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge ftom any part of the qwation?
4. Was then any adverse impacts to the waters of the State other than from a discharge?
S. Don any pan of the waste management system (other than logoonvUlding ponds) require
13 Yes
ffNo
El Yes
MNO
E3 Yes
19NO
13 Yes
9[No
0 Yes MNO
13 Yes 0 No
13 Yes KNO
13 Yes WN0

6. Is Seth► M in Compliance with any applicable setback criteria?
13 Yes JRNo " ' ' •
7. Did the facility 6D b have a certified operator In rasponsiVe dwr (if inspwdon dWr l/U9'%i? 17 Yes 0 No
B. Ara rhea lagoons or storage ponds on site which need to be properly closed? ❑ Yess 15 No
Structures R.aaootts AD4101 HoWlsg too
9. Is strueutal 5teboard less am sdequxte? 0 Yes Ei No
Fieebowd (i3): &umn l Lagoon 2 Lagoon 3 Lgooa 4
10. Is seepage observed fivm any of the Mean? E3 Yes ,® No
11. Is erosion, Or any other threats to the integrity of any of &e structures observed? D Yes ja No
12. Do any of the asmwtums n LD Yes M3 No
(If any of questions 0-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start Cad stop pumping levels? E3 Yes ® No
Waste A nD"r- ge
14. Is there pb*csl evidence of over application? r-I Yes 0 No -
Of in excess of WMP, or runoff entering waters of the State, notitj► DWay
1S. CMP type .,.�.._...
16. Do the active crops differ with those designated in the Animal Wam Management Plan? Yes ® No
17. Dos the facility ban a tack of adequate scnz a far land application? 0 Yes 14 No
18. Dow the Cover crop need irapravftcnt? ❑ Yea 2tNo
19. Is there a lacy of available irrigation equipment? E3 Yes ® No
f =Qriifled_ Facilities 4rrly
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? 13 Yes MNo
21. Does the facility fail to comply with the Animal Waste Management Plan in any wayf &Yes ANo
22. Does record keeping need improvement? ja Yea ❑ No
Z. Does facility require a follow-up visit by same sgencyl 0 Yes . RNo
24. Did Rcviewedbupector fail to discuss mview/mspec on with owner or operator in charge? ❑ Yea 10 No
Co=vtats-(refer to quah6n lxplain arty. YES arisa+ers aadlorsuy i comrtieadations ortiny ei co ` 3 ,
to' better axplaii� atnegoaj:: i e of ar pegea a 'goa )� - i
Uce'Rliaayaiags ei'faoi4tyID
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/l�lw �r.� N—
Ho
Revkwer/Inspector Name
RrAwer4nspecter Sipatnre: ��..✓f / Date:
= Divitlon of Water Quality, Water Quality Seedou, Fi dU& 4sseninent Ua t