770013_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

FacilitylYumber
..... J _ - - -_..
Division"
O':Division,
Q,OtherAj
3
f Water:,Quality,_ P gam, ka
f Soil and Water Conservation;
,ncy__F..
IType of Visit 0 Compliance Inspection O Operation Review O structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Fallow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: [ I Arrival Time: Departure Time: O `3� M County: Region:
Farm Name:. _st l I ++ i1+ta.Vl TOIA, Owner Email:
J t
Owner Name: 12 Lt%i'O{ cadb Van Phone:
Mailing Address:
Physical Address:
Facility Contact: 2LOld SJA�%A r-, Title: Phone No:
r �
Onsite Representative: t,l Integrator: N�- Puaabs
Certified Operator: U Operator Certification Number: --/ 83 30
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = I{ Longitude: = e = 6 [� si
Design Current
.,Swine " Capacity Population' Wet Poultry ,
❑
Wean to Finish
❑ Layer
❑
Wean to Feeder
❑ Non -Layer
Feeder to Finish
Dry Poultry,
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
"Other
❑ Other11
Design; , . "Current , 4t
.apacity " Population Cattle
El La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream I_ mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
r
w
[3 Dairy Cow
El Dairy Calf
❑ DairyHeifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
El Beef Brood Cow
Number of $true#u l
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
�d NA
❑ NE
❑ Yes
❑ No
[dNA
❑ NE
n NA
❑ N E
❑ Yes
❑ No
❑ Yes
ff] No
❑ NA
❑ NE
❑ Yes
$ No
❑ NA
❑ NE
12128104 Continued

• Facility Number: 1j — L3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
QQ 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
Spillway?: 7
Designed Freeboard (in): 12,
Observed Freeboard (in): I o i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
YX No
NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
9.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
;K No
[ 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
® 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?
11, Is there evidence of incorrect 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 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19 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
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
INNo
❑ 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.
Use drawings of facility to better explain situations. (use additional pages as necessary):
. f aV M 15 5�-; I I o�era�► t� ,, .�O l�/a.� .e
`5�,
ii
ry RCS fDa G�' (0900,A C6srJh al- SWVIE � -`a/P.iJa`r6,S, /
NSi qq h i S 2 �; C-I . �vi'I ✓V11� AL��Qo� `tL� 0+^2 ! �YP •�,. lah
�1
Reviewer/Inspector Name i - I Phone: �?
Reviewer/Inspector Signatur Date:
Page 2 oj3 12128/04 Continued

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 [N 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 [P 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No El NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[R Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
P Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
OD No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
It No
[:3 NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
69 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
&9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[BNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
aq j "15 - S1 St ta-vt4j aAlj
6e 4ve- Aso
`- C.�7►n I AG'L" �ah y �OOY'� c� l�} Cr �G�t'V� r
Page 3 of 3 12128104

High Freeboard Evaluation Form
Facility Name: 5 (4 I 1 VO•v.� Poo-,- 1.4 Facility Number: 7 T - 13
Person Completing Farm:Oki, Date Form Completed:
Date Information Due to DWQ: Date information received
Extension Due Date:
Information Received:
Current Freeboard Yes _✓No _ Level(s) (in inches)_ _
Freeboard Levels for Previous 12 Months Yes I <
S-S- 03 1.,!� '
Incomplete
Spraying Records for Past 12 Months Yes /No _ Incomplete
Rainfall Records For the Past 12 Months Yes No ZNIA ____ Incomplete
Cropping and PAN Information Yes ZNo _ Incomplete
Summary of Actions Taken to Restore the Needed Freeboard(s)
Yes ,,-"No _ Incomplete
Description of Water Conservation Measures In Use
Yes — No _Incomplete
An updated POA if the Freeboard is still in Violation Yes — No _ NIA v
Detailed Description of Actions Taken or Proposed to be Yes _ No
Taken to Prevent Future Freeboard Violations Incomplete
Date High Freeboard Level Was First Reported to DWQ by Producer 3- 10 _ a3
Date of First Violation from Farm Records 3 10 - o 3
Items proposed in the Plan of Actions to Bring the Facility Back into Compliance
Pump and Haul Remove Animals . Delay Restocking
Add Land to NMP Add Application Equipment
Spray when site is acceptable Others (Please Specify)
HFEF 5-12-03
l

Information for Lagoon(s) or Storage Basin(s) (Add Additional Pages as needed)
Lagoon Storage Basin (Check as Appropriate)
Lagoon or Storage Basin Identifier
Design Total Days of Storage for the Facility (From CAWMP)
Stop Pump Level for lagoons or the bottom of the storage basin (inches)
Lowest Liquid Levels Reported in the month of:
Month
Date
Level (in inches)
August
-7
September
Z - O Z
October
/4 - 7 - b 2
November
/J - Y - b 2
3
Required Minimum Freeboard (red zone in inches): A
Does the Minimum Include a Chronic Rainfall Factor Yes ,--"'No
Recorded Freeboard Violations
Date Level (in inches)
3_�n-o3 I f�
h tey
^3- 21-63 L7 _
�°� � �\ �-31 -off_ (jD • S .
Date POA Su miffed
5 or.30 day
HFEF 5-12-03 2

Facility PAN Balance From the CAWMP (pounds) - Z 5z/5
Did the Facility Comply with its NMP for the Past 12 Months Yes A No
If No, What Violations Were Identified:
From the review of the facilities irrigation records, does it appear that the facility made
optimal use of the days when irrigation should have taken place. If not, please explain:
If the Facility has Installed Water Conservation Devices, what devices were installed and
when:
What Actions have been taken or proposed to be taken by the Facility to Prevent Future
High Freeboard Violations (check appropriate items):
Better Management of the System
Add Additional Storage Volume
Add Lagoon Covers
Add Additional Land Application Sites
Add Additional Irrigation Equipment
Install Water Conservation Equipment
Reduce the Number of Animal at the Facility
Change Type of Operation
Others (please explain):
HFEF 5-12-03

If applicable, recorded rainfall data from August 2002 through April 2003 at
Facility #
Month
Amount of rainfall
er month (in inches)
# of days it rained
per month
August 2002
Out of 31 days
September 2002
Out of 30 days
October 2002
Out of 31 days
November 2002
Out of 30 days
December 2002
Out of31 days
January 2003
Out of 31 days
February 2003
Out of29 days
March 2003
Out of 31 days
April 2003
Out of 30 days
Total Rainfall
out of 274 days
Comments from Producer:
Comments by Reviewer:
HFEF 5-12-03 4

x , . r`j Division of Soil and Water Conservation =Operation Review
' Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality Compliance Inspection.
Other Agency - Operation Review.;%
LQ Routine' O Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSIVC review Q Other
Facility Number Date of lnspcclion I Jr / -F
�,,,-�, - ---- -- - -- - ,,,,---_-_-- Time of Inspection r 1 ' 00 124 hr. (hh:mm)
0 Permitted 01C
ertified [3Conditionall Certified 13 Re istered
��''Oy % h ❑Not (} crational Date Last 7erated,
,,,,,,
Farm Name: ......L.f1 l.. County: ... .1 !i .I..........
OwnerName:..... »». iLC 4........ sm1Phone No:.......................................................................................
FacilityContact: ....................................................... ................Title:........................................... ......... Phone No.....,.....1l.............................................
Mailing Address: ».... �:3��._». ��� .»..�rp-� ..........»....»»..»... >���»... �.. l.li..C. .......,`�31.-
OnsiteRepresentative: .......................... ...... ».......»........»...».....»».. Integrator:.» ».......�..
Certified Operator:,,,,,,, ,,t.-X4:Vl. ........... »........ KC,L.! U " :...... .. .... Operator Certification Number:.........,.,,,.,..,.., ..............
Location of Farm:
Latitude 4 1 �� Longitude » =' ="
INwtne
Wean to 1 eeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 3
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds./ Solid Traps ❑ No Liquid Waste A1anagement System
Discharge's & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes ❑ No'
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. II" discharge is observed, did i1 reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?' ❑ Yes ❑ No
2. Is there evidence of past discharge from any part.of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts to the waters of the State other than from a'discharge? ❑ Yes ❑ No
Waste Collection R Treatment '
4. Is storage capacity (freeboard plus storm storage) less than adequate? *Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches): .......
._. ...................................................................... » ....»».».................. »....»...
� .......»........ -...». »» . ....
1/6/99 w . Continued on back

Facility Number: - Date of Inspection .5r
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 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 top of dike, maximum and minimum_
liquid level elevation markings? El Yes ❑ No
1.
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
] l.; Is there evidence of over application? ❑ Pontling ❑ Nitrogen❑Yes ❑ No
12. Crop type .......................................................................................................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW MP)? ❑ Yes El No
14. Does the facility lack wettable acreage for land application? (footprint) ❑Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily`available? h .
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑Yes ❑ No
hTo.vialatioits•tir. deficiencies .Were noted. during Ais visit:. V-611' M*III 'receive nv further
ccjrrespbddence'abotit'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):
Reviewer/Inspector Name �—
Reviewer/Inspector Signature: Date: d5'-% - c
94L= 11/6/99

rd w
�. i _, [e;
4 t , t l O'Divrsion of Sai! and Water Conservation Operation Review
S E� D:Division of Sail and Water.,Conservado`n .Compliance inspection ` E'
,.� 'DiAsion of Water Quality :,Compliance Inspection)
12 Other Agency ;Operation Review'
19 Routine - IIIII IIQ Complaint O Follow.up of DWQ inspection Q Follow -tip of DSWC review 0 Other
IIIIY - Y- - �^
Facility Number Date of Inspection
Time of Inspection g: 50 24 hr. (hh:mm)
j, Permitted [Certified [] Conditionally Certified 0 Registered 10 Not Operational Date Last Opera ed.
J Q I 1
Farm Name . .............✓`tl..h� `'�^'?...,.I. LL-- County ............ �1. l;'FJ'V)...............ovi ................ ....... }............................................
Owner Name: .. !�.l.t?�.....,.�{5...1 t.r?......�1...... Phone No: TO ^9�� a0... ..
bmd
I%................I........ ....... .............
Facility Contact: ...................���l.f......5. 1............. Title• . Phone No:...................................................
lf�W
.............................................................
Mailing Address: ........�!�...........L#�!1��f........�� . ....................... .....,.............�Q.C.14.�... '��.�?!'1...` AIC ......-1f39F
Onsite Representative: , �,� • Integrator, '. �,........ ..
Certified Operator: XI . ........................... it �f r v�......................... Operator Certification Number:.........,��.............1.......
�O
Location of Farm:
a
....I ............................ .............. ............ ..... ................
Latitude • 6 fi Longitude • ' 44
i I Cad a t Po ulaHon I Poultry:'
'� �t' Design Current ;' Design 'Current
Swine,, i4{i II lI " ' Cattle ii
t Y [ Ca ad . Po' F'ulatibn Capacity . Po ulation
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
[IFarrow to Feeder ❑Other
J❑ Farrow to Finish i Total Design Capacity 3J�
❑ Gilts, t k I
E3Boars ;'; :T6ta1.SSLW
I� } Subsurface Drains Present ❑ Lagoon Area Spray Field Area
I� IHaldlin Iml'and /Solid Tra s iF I' E ❑ N ,.
t
Ea
,� g ' p. ��� ❑ o Liquid Waste Management System
i i. ,di " d R , u.
Discharges & Stream Impacks
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment r
4. Is storage capacity (freeboard plus storm storage) less than adequate? [ Spillway kf Yes
L Structure 6
Structure I
Identifier: ii it
/ll
Freeboard (inches) : ..............i.. �T..
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes *0
❑ Yes No,
❑ Yes !!! No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes XNo
❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
Continued on hack

Facility Number: 79 — 13 Bate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes (WNo
(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
CKNo
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? ❑ Excessive Ponding ❑ PA
❑ Yes
'� No
12.
Crop type _j g L.,.& ,
13.
Do the receiving crops differ with those designated in the Certified Animal YvUte 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? ad
❑ Yes
❑ No
15.
c) This facility is pended for a wettable acre determination?
Does the receiving crop need improvement?
❑ Yes
Yes
❑ No
KNo
16.
Is there a lack of adequate waste application equipment? ►�•-
❑ Yes
ANo
RecLuired-Records
& Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
IgNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
[YNo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�f 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
frNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
lxqo
24.
Does facility require a follow-up visit by same agency?
Vyes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑] Yes
j No
0• .. viglaiiOs',o� d$�e�endo$ r�trre �Qteo�>Grring �h.1s;visa; Yo>!t will iec$iye �o: fu0�
corres• Tideh& A6Uk this :visit.
-2:# E-EC !E .�..i €. � .........
E E
Gomments(refer,,to,questton #} Explam anylYES answers and/or auy`recommendations or',any,oti►er cotniments
f, t 9 ,.E, . € ,E 'tn li:I, E: !!�! . ,:„E€ 4„ 3 �.11.:!'. E E..&?, €-<1.l:t,i:.� i'.ni?�`.-Eiit9i.E.__,.- :. °,.€ €nr= ,l:,i .':i: L i .E ,.. i''-`E, ,l ,.it..Sl i .i',. # .s._; 4a.=f .:t! : Er. f:
Ilse drawings of facility,to betterexplain,sttuatigs 1(uge�addetianal€ pages`as-necessary}{� �� s t l€ I�,, > ¢.,
., ii k':., F3 e - !
4<Oa
ail AW
1;104&q Awn 4"
Reviewer/Inspector Name I ? , ?' V + `-
Reviewer/Inspector Signature:
Date: ,r-
3I23199

i. ii
�Q [3Division of Soil and Water Conservation ❑ Other Agency F
Division of Water Quality
'f
Routine O Cam laint O Frollow-u cif I)W ins ection O Fallow-u of DSWC review 0 Other
Date of Inspection �.
Facility Number � � 24 hr. (hh•mm)
Time of Inspection .'
Registered Certified [� Applied for Permit 0 Permitted j] N'ot Operational Daate Last Operated:
Farm Name:.. r4��l��tl4rF4 ..... L..43.t�t.�.... County:........Ch1rw.'`i................... .......................
90
Owner Name:..,...�l.t....................t;i .�..�.1..ILC>< h„� Phone No: /�,� ! ..Ci' .�. ............
I
Facility Contact: ....D CLS , ......su.i.1.�,1r? .. Title: ... O4sx.arf.Rt r7......................... Phone No:.. ,,ram ..............
Mailing Address:......... �.�......�` h kJcs.,.!+:................................. ...%�',tt °., ,.�� .....,..., ..3 %
P
Onsite Representatly :........ 50 .......................................... Integrator•........A �........ nvIs ............................... Certified Operator-,.. �. �t-r-
p Q�...�?.......................... ...............�.. +...... ..................... Operator Certification Number:.....:...................................
Location of Farm:
Latitude f_I•�c�cc Longitude• L_Jc �cc
r �' '
D eslgn :; Current"`
; Design , "Current'Dcsign , '' Current
Gapacrty "Population
Poultry Capacity Population Gaftle Capacity Population'
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
I0 Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
r;`
❑ Farrow to Finish
: z
Total Design Capacity"
2 $'
❑ Gilts
El Boars
Total�SSLW
Numb,6 of Lagoons / HoldingPonds `
❑ _Subsurface Drains Present
❑ Lagoon Area
I0 Spray Field Area
` :.
,
d
F
❑ Na Liquid Waste Management System
Ueneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon [I 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 gaUmin?
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? El Yes I
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 fNo
o
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes
7/25/97 Continued on hack

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes XNO
Structures (Lagoons,Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes X\110
Structure I Structure 2 Structure 3 Structure 4 StruMlre 5 Structure 6
Identifier: ............. I ............. I....... .... ..................... •.......•......... ............. ............... ............. .........................................................
...................................
Freeboard (ft): ........ 2.0 ....................... ........................................................................................................................................
........................•.
.. ....
10,
is seepage observed from any of the structures?
❑ Yes
KNI o
11.
Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
f N0
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
�,` 0
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
XNo
(If in excess of WMP, or runoff ente 'nRg waters of the State, notify DWQ)
�r%!c.....Ll.
15.
Crop hype .... .................................... .......... ................
...................................
16,
Do the receiving crops differ with those'designated in the Animal Waste Management Plan (AWMI')`?
❑ Yes
XNO
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
QrNo
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
o
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Z,No
22.
Does record keeping need improvement?
Yes
;(No
For Certified or Permilted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
❑ No
No.violationsor deficiencies were noted during' this.'visit.: You.wvill receive no further
correspondence about this visit'.,',
Cotnnxt nfs:(refer to;queston #): Explain any YES answers, Ind/or riny reentiitmenctatians or any, a
CJse dtirawmas of facility to better explain situafMns (use adcliti+tnal pa e4 as eeccStiary). ;
is `fir*.. looks 4 4- kielt j4tGLcn IL
t .
We tt reimevcd -CroA, jajkvn. ems,
7/25/97
Reviewer/Inspector Name S
b
Reviewer/Inspector Signature: , e , Date:

Int O Follow-up of
I Facility Number 7 Z_ I
Farm Status:
�tion`�Rev><ew k
lion:R.
Site nspe�ch'on� y.
allow -up of DSWC review_ Q Other
Date of Inspection
Time of Inspection Use 24 hr. time
ITotal Time (in hours) Spent onReview i
or Inspection (includes travel and processing)
Farm Name: 15- 1 JCL & FV L, t--ram County: ,_ i C rnor� d
Owner Name: ---� 0.� �_ d GJ • ,�4. i i var`. Phone No: NO) 9 9 7 - z D i S
Mailing Address: 3L4Z i nwoo Lctne 16k am ri C Z 8379
Onsite Representative: ,,, a.� i d S" f 1"►i a v� ---- -_ - __ -- Integrator: N/A---
I f
Certified Operator: ,_... G v + d S� f r' v c� Operator CertiScadon Number:
Location of Farm:
o ' i d 2 e SQ /,4 SD . Z r►a� er k q4? er
8
Latitude Q• Q� u Longitude
0 Not Operational Date Last Operated:
Type of Operation and Design Capacity
t a s y x, r ? 4 P nk w;a5 } >2�..}
SwEne ry •r ti. . x r..,.4 P* YAK> 3 3�. mot:. MNnmber �;# Ponitrya�, 'Nnmber M Cattlea* M311umber ;
r .,
El Wean to Feeders ❑ La ❑ Da'
❑
Feeder to Finish Z ` £ ❑ Non La Beef
Farrow to Wean
to Feeder
Farrow to Finisha[] Other Type of Livestock rkk�2x ,w
�"#k you "'_ axa,,,.,.,,s �,^ �€�;�' r ir�•,;.$;aa" C,�: Y,.33s
<; Number of Lagoons 1 Holding Ponds ' ❑ Subsurface Drains Present
Lagoon ❑ S'ray Field Area n
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWt)
e. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
o,No
❑ Yes
® No
❑ Yes
❑ No
❑ Yes
❑ No
4. Was there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement.?
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes ONO
M Yes P.No
Continued on back

6. Is facility not in -compliance with any applicable setback criteria?
E3 Yes
No
7. Did the facility fail to have apertified operator in responsible charge (if inspection after I/l/97)?
13 Yes
No
.8. Are there lagoons or storage ponds on site which need to be properly closed?
E3 Yes
No
.Structures (Lagoons and/or Holding: Ponds)
9. Is structural freeboard less- than adequate?
E3 Yes,
O..'No,
Freeboard (ft),,` Lagoon 2
e7 �OOn Lago&i3
Lagoon 4
10. Is seepage observed from . m any of the -structures?'
0 Yes
No
11. is ems'On, Or any Other threats tpthe integrity of any of the structures observed?
ED Yes
�No
12. -Do any of the structures need maintenance/improvement?
0'-Yes
ONO
.(If any ofq'u:isiio'ng 9"-'Id'w-as,a-6sWered7yesj and the situation poses an
'finmediate
public health or environmental threat;' notify DW Q)
-13. Do any of the structures lack'aaqtiiie markers 'i6'1dehtif start and -stop pumping levels?
Y
((Yes
E3 No
,NN"aste Application,
7
14. Is there physical evidence of over application? -
13 Yes
JqNo-
.(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. . Crop type er ftLk� C'L
16. Do the active cpps:,differ with those-designated-.in`'Ahimal ManageiiiefitTia'a?l
Yes ION6'.
17. Does the facility have a lack of adequate acreage for land application? 0 Yes Q No
7-7 ,
18. Does the cover crop need improv"i?
E3 Yes RNo
19. Is there a lack of available irrigation equipment?
13 Yes No
For Certified Facilities Only
20. Does the facility . fail to have a, copy I of the Animal Waste Management Plan readily available? 13 Yes E3No
21. Does the facility fail to comply with. the Animal Waste ManagementI Plan in any way? E3 Yes, '13 No
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same-agenby?
24. Did keviewei/Inspector fail to discuss review/inspection with owner or operatI or in charge? - -
13, 5-vf - 54-tr+ fa mp mtrke r needs -�O be- 1"'5-6al
Reviewer/inspector Name
Reviwerftnspector Signature:
cc.- Division of fflater L?uq1io, Kidier Quality Section,
Assessment Unit
0 Yes 13 No
13 Yes 0 No
Yes 13 No
W
Date: 7

E3 Division of Soil and Water' Conservation - Operation Review ,
. Division of Soil'and Water'Conservation Compliance,Inspection
C S on•of Water Quality Coirnplian•ce Inspection E •: »,
Other Agency,- Oper'aow eview.,
10 Routine Q Complaint Q Follow-up of DWQ inspection 0 Follow -tip of DSWC review Q Other
Facility Number / DAte of Inspection
Time of Inspection 24 hr. (hh:mm)
gPermitted [3 Certified j] Conditionally Certified © Registered 10 Not O erational Date Last Operated:
D
Farm Name: ....SeL IIi Ja..�....../.{iT.............................................................. County:........./4.•`•.4.''� �f...,......................................,
Owner Name: ....Dakz.+.. ..... /..(..l.Y Phone No: % r'J. ..r ...................................
... ........................................................... ........ ..... ..... �..
Facility Contact: ..........f... ...................................Title:...................... �­4..
.......... Phone No:......./....... �..........I........
Mailing Address:...........Z,.....-.l..M,f.��.?.4?.f�'.....r� .............................. .....d.!�. .�h.�?! lil......... f�3..7/.....
Onsite Representative: !I'�1 ................�........ J..................................... Integrator.* rArz.s .................................................
Certified Operator:.........................V�'..-......... ......./.l.L....Y.�.................... Operator Certification Number:..........................................
Location of Farm:
.................................. .. ...................... T
Latitude 0 1 •6 Longitude • 6 «
Design
Current ' "Design
Current ; ' Design Current
Capacity
Populati'PoultrSwine oCapacity
Y.
Population Cttln Capacity Population.
❑ Wean to Feeder
❑ Layer
❑ Dairy
a
�i0
eeder to Finish Z
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
iE 1 a, Art a , 1,,11 , Ii.,
1 it,,.
❑ Farrow to Feeder
❑ Other
y..
,
❑ Farrow to Finish
t
Total Design Capacity Z
❑ Gilts,
❑ Boars
; "
-Total SSLW
l Nugmber of Lagoon t =i ❑
Subsurface Drains Present ❑ Lagoon Area ❑Spray REED
3
` I } $.,
�H,l' Pontds I Solid Traps ' ❑ No Liquid Waste Management System
t ; E_
oldin
Discharges & Stream Imts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes kNo
b. If discharge is observed, did it reach Writer of the State? (If yes, notify DWQ) ❑ Yes � o
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier: r� l
Freeboard(inches): ....... ` ..................................................................................................................................................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ANo
❑ Yes $CNo
❑ Yes ONo
❑ Yes ASZNo
Structure 6
...............................
❑ Yes No
Continued on back

(Facility Number:77 — % 3 Date of Inspection
D
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
o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
kNO
Waste Application
!
10, Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ E ssiv Ponding ❑ PAN
❑ Yes
o
xce
12. Crop type AP
13. Do the receiving crops differ with those desi at 4 in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gNo
f
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ErNo
b) Does the facility need a wettable acre determination.
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
ZNo
I
15. Does the receiving crop need improvement?
❑ Yes
Mir
KNo
16. Is there'a lack of adequate waste application equipment?
❑ Yes
ENo
Required Records & Documents
17.. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
.10 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time.of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
WO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
['No
24. Does facility require a follow-up visit by same agency?
❑ Yes
ZjNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
5To
No flol� tioijs'ot, ftacjepoies wore hPtpo. St1t•I`iog 4)hls'vpsat;• Y'oj� Will-teeoife oo. fpfther: • . .
• corresnorideh& about; this visit, . .................................. .
�.. 11 i+�!:§..(-. i
[Ise drawings_ of�facllity�toilietterexplain�situatiotis�{use,ad�tional€pages awnecessary)
{? ,r:, a' a" 1 .I.-h«i•% Y- i i' ,y�.- cr ;ti'- e..S 3 F- .,- ,-1
Ile r C"j h7 7' r"
�� J`ecordS,
} Y i""— �' }� -" iry - r i ; p—w�•---srr—t�"' •— .?j.
Fr-T—F.ei r—
Reviewer/Inspector Name 3.. € =':�s �ir ���;.' ..? t k ".,'�.`,g
Reviewer/Inspector Signature: Date:

Facility Number: 77 — /3 Date of Inspection
Odor Issues '
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes AE'NO
roads, building structure, and/or public property) " 1
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes eNo
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 j No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �EJ44o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

3
i � ii��i�i r �li� '�t1 � ii' r �,`tF �3 �i��� i F Divtslon,ofwater,QUehtya � . r i13 ��.E� �(.' �i t t • '. � I ,(> � f 3r.
is a Did MI fi of Sail and MaterConservation
j(x� tl i l c Y c E €13 � � cl �•J .� ° � ��i,Q_thier Ajeilcyo �33. I
j 5
7.. I itifc_
Type of Visit XCompliance Inspection O Operation Review O Lagoon Evatuation
Reason for Visit ORoutine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Numberer
(fate of Vkit. - -�� Time: � Printed on: 10/26/2000
7
o Nat O erational Q Below Threshold
Permitted © Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: 5{�,..�..�.t.i/P-7n..... plmJ-,
r! 13'................................................ County:... � .!u.................................
r�.
l
OwnerName:... ...U.1.%� ......... lli.tlGlrrr-�............................. Phone No:...........l...g7. 2Q 57. ............................... .................. ........
Facility Contact: .......... "jr' -`e................................ Title:................ ................................. Phone No:........... r......"..................
Mailing Address:.! z�n.!�''t?<(� L ... ......................7/
�... r......... � . �r.r•��r.. ,-�.....INc 2 5- 3
Onsite Representative:.........�l�l Ali..�.................................................. Integrator: .......... %V �� .... A(gill.s..............................
Certified Operator:......,.r,./.Q�......'..........,w/uC%- - Operator Certification Number: ..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` 46 Longitude • ' 4�
Design Current Design Current Design Current
Swine Capacity -Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 ❑ Layer I ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
[]Boars Total SSLW
Number of Lagoons [[—:]Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I 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 Ficld []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. Il' discharge is observed, what is the estimated now in gal/min?
(1. 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
S11-11CIUre I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........................................................................
Freeboard (inches): 31
S/00
❑ Yes KNO
❑ Yes PiNo
❑ Yes ` qNo
❑ Yes frNo
❑ Yes gr0
❑ Yes � IkNo
[]Yes XNo
Structure 6
Continued on back

J
Facility Number:'77 — ,jW I Date of .Inspection -A/-O/ Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes 6io
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes A
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 ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes AKNo
Waste ADDlicatiOn
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ E� cessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes X-No
12. Crop type L7et &elar 144.! / I-0e Dup�'1Cea✓
13. Do the receiving crops differ with those dl signated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
RE 9,No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
P�No
b) Does the facility need a wettable acre determination?
❑ Yes
J�No
c) This facility is pended for a wettable acre determination?
❑ Yes
Q�No
15. Does the receiving crop need improvement?
❑ Yes
�D o
16. Is there a lack of adequate waste application equipment?
❑ Yes
[gNo
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes YNO
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 PNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes �No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JWNO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes "No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes UJ No
24. Does facility require a follow-up visit by same agency? ❑ Yes OZINo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes f jXo
.: � •'4'iQlp�ilggs'pi' �1$�£)ea��� •vv�re h4�e�. �1�i�>; �.h�s•vjs�t; � Y:ot� i��� •>ree�i j�e 1[io f'ujt��r:
comes• • ttidei & abauf this :visit.:
Comtents'(iefer ta'questlon #) Explain any.YES answers'and/or any recom>inendations orFaay other cornmentslri"
Use drawings of facility to better explain situations (use ailtlitional pages as
rr �/
rRrm jS ran �a� r4t4�ae/ &fell «fq,; 7���+tel
6onpl rec&4,
Reviewer/Inspector Name Q;
Reviewer/Inspector Signature: Date: ^- r' 5/00

Facility Number: — Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Ayes ❑ 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 4NO
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 o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fiil pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments an or ra n s
l
5100

,f 2_J.. ./1-J,k
1 ' ��
� �IQ111L
Facility Number
Ip��
I�LJ
-
i
fHG��I
fl
Ibivis""ion of W"at�rResources
4°' Division of -Soil and Water Conservation
C?'Other Agee y
...Ir„r,.�..»
Type of Visit: OCompliance Inspection Z3 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access /jam
Date of Visit: 9 1 y Arrival Time: Departure Time: County: Pa-4 ,(Region: iF-i`-tJ
Farm Name: t / i/«� r Owner Email: if
Owner Name: Lev S w� �r �1-� Phone:
Mailing Address:
Physical Address:
Facility Contact: f j,J� Sk r\144L Title: Phone:
Onsite Representative: iJi Integrator:
Certified Operator:
Back-up Operator:
Certification Number: Vse.)
Certification Number:
Location of Farm: Latitude: Longitude:
tltiHil��llpl
Design,
IIiI11�N
Current
Design
Current
Design Current
swine
�EMIIAiaar�
Capacity
fltlkl
li'op.
Wet Poultry
"9kp3l�,r
Capacity
Pop.
Cattle Capacity Pop.
tlilliii9!{i
till4i9uWiY{1liY
�hG,�t
€
1
I�
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Ma
Current
D Cow
Farrow to Feeder
Dr 1?onIt
aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ® No ❑ NA ❑ NE
❑ 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
Li 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
P No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: -7 Date of Ins eetion:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
50 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):
1
Observed Freeboard (in): 2-74
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 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
® 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?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W 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 %'❑ Evidenc ofWindDrift El Application Outside of Approved Area
12. Crop Type(s): a S L4" � 44
13. Soil Type(s):
14. Do the receiving crops diffe from those designated in the CAWMP?
❑ Yes
o
❑ 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
T
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 CAW MP readily available? Ifyes, 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
❑ 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

I+aciii Humber: Date of inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RjNo
❑ NA - ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
I 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
T�
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
1W 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? Ifycs, check the appropriate box below.
❑ Yes
[p] 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
No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L} No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5a No
❑ NA ❑ NI:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: fllf'`F '� 3 G'b
Date. �1_6bl
21412015

(Reason for Visit: ® Routine Q Complaint Q Follow-up Q Referral 0 Emergency O Other O Denied Access
Date of Visit; Arrival Time: :'y Departure Time: ;? County: R ICI,10140
Farm Name: Owner Email:
Owner Name: ��l U �`Gl � K �.' r`�lalrl Phone:
Mailing Address:
Physical Address:
Facility Contact: DAV la S w1 I, �/ah Title:
Gt
Onsite Representative:
cl
Certified Operator:
Phone:
Region:
Integrator:
1241)
Certification Number: 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity':
Pop,
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
JNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
DrF P,oultr
Ca acit
Fo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other1jrjOther
Discharses 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
[:]Yes [:]No
❑ Yes [:]No
❑ Yes W No
❑ Yes 1] No
] NA ❑ NE
[� NA ❑ NE
NA
❑ NE
❑NA
❑NE
❑NA
❑NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: 1 I
c
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 Structure 4 Structure 5
Identifier:
No ❑NA ❑NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� N
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 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
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?
Yk
Waste Ap lication
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes
DQ 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 Pending ❑ 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 ❑ Evid
enceofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C � p "5 5 �P-, L}-► a,.LY Q V-efc,-�
13. Soil Type(s): A&Z!,
14. Do the receiving crops di er 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
LP No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1W 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 P] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[3 NA [3 NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F ciIi N. mber: I I - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 6 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rMNo
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 9 No
Other Issues
�] NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �KpNo
❑ 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:
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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/11
Phone: "10133-3 300
Date: iL-4
1 In
214/ 011

(Type of Visit: ® Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance j
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: �/ Arrival Time: r Departure Time: County: Region:
Farm Name: s`s!/ 'V�/ Owner Email:
Owner Name: QQJr �f �u1� Phone:
Mailing Address:
Physical Address:
Facility Contact: �q JrW'sc'ell(L44 Title: Phone:
Onsite Representative: !i Integrator: La-. po-.1rik
Certified Operator: Certification Number: F 330
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pap.
C>attle
Capacity Pop.
Wean to Finish
ILayer
aig Cow
Wean to Feeder
Non -La er
I I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, F,nultr,
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Othe
I
ITUrk Poults
Other
I
I Other
Discharees and Stream Imnacts
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
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
F] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

i
Facill Number: Date of Ins ection: 3
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 RNA ❑ NE
St ruc re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 h
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[7 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
jo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
FZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes T 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):4
Kd VtSi
13. Soil Type(s):
2
14. Do the receiving crops di er from those designated in the CAWMP? ❑ Yes EP
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
00 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
1P
❑ 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 j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

i
Facility Number; 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
f�pNo
❑ NA
❑ NE
❑ Yes
[�L No
❑ NA
❑ NE
❑ Yes �q No ❑ NA ❑ NE
❑ Yes `p No ❑ NA ❑ NE
❑ Yes "No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
rUsoemdmrawings
ents (refer to question #): Explain any YES answers and/or any additionai;iecommendations or eny L titer comments ' K
of facility to better explaln_situations, (use additionalxpagesas,, necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: fl0- 3u
Date: 313 /&
l/ /2014

?l
Division of Water Quality
Facility Number ®- © 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: J L f jIVA w Owner Email:
Owner Name: S2i yt Ol Ste. I I +tea fx Phone:
Mailing Address:
Physical Address:
Facility Contact: �ij u,-d .Su. t V*q Title: Phone:
u
Onsite Representative:
Certified Operator: K
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator: NUT
Certification Number: g33
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes P No
❑ Yes � No
®NA ❑NE
�]NA ❑NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

• `r
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�pNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
{ 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
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acce table Crop Window ❑ Evidence of Wind Drift ❑r Application Outside
�of1Approved Area
12. Crop Type(s): ("�wah),......J �','- '
13. Soil Type(s):
N. Do the receiving crops differfrom 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
,
❑ NA
❑ NE
❑ Yes
CT
No
❑ NA
❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M 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

Facility Number: Date of Ins ection:
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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes M No ❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes QgNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes TT No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer4o,question #): Explain any'YES answers and/or;any additional,recommendations or anyjoth"ernommentsi , t4
Use drawings of facility to better explain situations (use additional" ages as.necessar
ria�so yr
� tl
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3 - 73
Date: 1 I
21412011

Z
Division of Water Quality /
Facility Number - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up -..r� 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I V1$ Arrival Time: Q '3GYi Departure Time: �� r County: AAA-4011egion: /Con
Farm Name: S j 1 i 2.i. 004't/4f"7Owner Email:
Owner Name: �� tlt`Dl. s,, 1l1 VCLt.%. Phone:
Mailing Address:
Physical Address:
Facility Contact: J i G( •S+i r �C n Title: Phone:
Onsite Representative: ti
t
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 32 Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator: /L)6C /Lyd
Certification Number: r g 33 0
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Nan-L
Pullets
Other
Poults
Design Current
Di_scharses 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)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
4=
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑Yes ❑No [ANA ❑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 [PNA ❑ 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 1 of 3 21412011 Continued

Facili Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [@ No ❑ NA D NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ( M
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EP 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
FE No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M 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
E� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!p 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
%p Window /❑ Evidence of Wind Drift 1 ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): A-
14. Do the receiving crops
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?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
[] Yes
[ y� No
❑ NA
❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EP 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 E;3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: r1q - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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:
r
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 6] 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 reco.mmendationa•or any' they comments' '1. ;
Use drawings, of facility to better.explain situations (use additional pages,as necessary):
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes © No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
Phone: �%� `' (33-- 3 3�
Date: 1 j S
2/4/2011

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time:g� Departure Time: ( County:Rj!gj/&Aj0Rcgion:
Farm Name: 5,1 1 t\\14.11 l OLL.I-I-q- y Owner Email:
Owner Name: �Qtl,� Sca� f �4y� Phone:
Mailing Address:
Physical Address: j
Facility Contact:y~� S`1l i1�ct r� Title: Phone:
Onsite Representative: Integrator: � ��tu'' J i 5
Certified Operator: Certification Number: 118 33 0
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity >'op.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P,oult
P.
Non-Dai
Farrow to Finish
JLayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I JBeef Brood Cow
Turkeys
O.the.r
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes �R No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes JA No ❑ NA ❑ NE
of the State other than from a discharge? 77
Page I of 3 21412011 Continued

Facilit Number; -13 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
a Observed Freeboard (in): w�
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
S. 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
Wo
❑ 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 j ❑ Evidence of Wind Drift [3 Application Outside of Approved Area
12. Crop Type(s): (24S-W �t�.tcL &a% C-l7 J r-5k , Greo, DlWW�j -
13. Soil Type(s): )6-V C.
14, Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
77©��
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
NA
❑ NE
❑ Yes
j No
❑ NA
❑ NE
❑ WUP ❑Checklists [:]Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5g 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

A
Facility Number: ri - Date of Ins ectian: I
f
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5 No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
o 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
P] 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
j 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:
T�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q5 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
jj No
Totlier
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answerscomittents rt° +A Jif_+
Use drawings of facility to better explain situations (use:additional.Uages'-as,necessary)
Sluff 5tLr u-4,`I 2-o ter
Reviewer/Inspector Name:
Reviewer/lnspector Signature:
Page 3 of 3
Phone: 910-LO-2 -3300
Date: Val/1 ';-
2/4/201.1

�f
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
::� 0 Other Agency
Type of Visit 0 Compliance Inspection 0. Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 I g Arrival Time: Q ; 'S Departure Time: County: Ma's% Region:
Farm Name: S4rI �iVCLh 1�0�fJ! "ti Owner Email:
Owner Name: Pgj,,d Sal E��VQL Phone:
Mailing Address:
Physical Address:
Facility Contact: a J .A Title:
Onsite Representative: t-f
Certified Operator:
Back-up Operator:
Location of Farm:
0
Latitude:
Phone No:
Integrator: ix)6- t ya;r S
Operator Certification Number: /1330 --
Back-up Certification Number:
Longitude: = ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
Layer
❑ i
Non-Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 2-5-
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other----
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & 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?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: =1
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 EDNo El NA [I NE
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
[�PNA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
5No
❑ NA
❑ NE
[I Yes
JUNo
❑NA
❑NE
I
Page 1 of 3 12128104 Continued

i
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [PNA ❑ NE
Structure 1 Structure 2 Structure'3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): e7
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.)
r
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ No El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
S
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?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[P 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) C. c
13. Soiltype(s)
l7
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
� No
❑ NA
El 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
P-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4 No
❑ NA
❑ NE
€�� � `.,.'���"'��xffi ��e��' F;
Coffthchts (refer to questiow#) Explain any YE3'.;answers_ and/oi•�any rec�mmendahons o,r��yyany other comments. "
Use�drawings:ofitAil lity4o better explain situns: atio(use�additional pagepas necessary#)�: fit,
Reviewer/Inspector Name `. . t x . E Phone: I o- ` 3-3-3
Reviewer/Inspector Signature: Date: 3 !
Pa Je 2 of 3 12118104 Continued
6

r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ 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 g ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[jNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus toss assessment (PLAT) certification? -
❑ Yes
❑ No
(RVA
[I NE
Other Issues
r
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IM No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
r No
❑ NA
ElNE
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
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings a o�' �� h' �� ``�� �<
i
T
Page 3 of 3 12128104

Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine Q Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: U`ll County:
Farm Name: ('" `'� ` Owner Email:
r c �
Owner Name: vl Ju t h Phone: _
Mailing Address:
Physical Address:
q� c .
Facility Contact: _pa_Vi ^t ,U `rah Title:
Onsite Representative: k
N
Certified Operator:
Back-up Operator:
Region:
Phone No.-
Integrator: 8G, PLa- /its r 2
Operator Certification Number: r J
Back-up Certification Number:
Location of Farm: Latitude: [= p = = Longitude: = o = I =
Design Current
Design Current
Design Current
Swine Capacity Population
Wct Poultry Capaci-PHliftioni
apacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
El Beef Stocker
El Gilts
❑Non -La Non -Layers
El Beef Feeder
[3 Boars
❑ Pullets
ElBeef Brood Cowl I
❑ Turke s
©thc
❑ Other
10 Turke Pouets
10 Other
Number o#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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
�9 NA
❑ NE
❑ Yes
❑ No
( NA
❑ NE
PINA
❑ NE
❑ Yes
❑ No
❑ Yes
tPNo
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
Page 1 of 3 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 ( No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes I❑ No NA [INE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
.5
Observed Freeboard (in): k
5. Are there any immediate threats t �r etrity oT-wli 'of the structures observed? ❑ Yes
PNo
❑ NA El NE
(ie/ large trees, severe erosion, seeps a✓etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
�] No
[I NA ❑ NE
through a waste management or closure plan?
i
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
Wo
❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
$allo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�a No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
MNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ 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
NPNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
G�OodFtwkK I
Reviewer/InspectorName Phone:
Reviewer/inspector Signature �— (� Date: 3 a
Page 2 of 3 12128104 Continued

r �
Facility Number: Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [)A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes GPNo ❑ 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
BNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
4NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ 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
5j])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
Y" No
ElNA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 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
WNo
❑ 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
Wo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'§ZjVo
❑ NA
❑ NE
Additi0nal:Comrrie.itts and/ar Drawings: z$
0
F
Page 3 of 3 12128104

('
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 41��Arrival Time: tI Departure Time: I (t1 ,GY.n County: 916HIYt olvD
Farm Name: Su IIi�t�,,► r DfY+a Owner Email:
Owner Name: DQ+�t W sk� t�/4►'� Phone:
Mailing Address:
Physical Address: f
Facility Contact: '�� S'ti ���h Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
O
Latitude: =
Phone No:
Integrator:
Region: EeO
Operator Certification Number:
I S 33o
Back-up Certification Number:
Longitude: =0=1
Design Current
Swine C+apacity Populatien
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
10 Non -Layer
❑ Dairy Calf
1❑
9 Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ La ers
❑ Non -Layers Pullets
❑
❑ Turkeys
❑ Turkey Pou Its!
❑ Other
❑ Da Cow
❑ Non-Dai
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
DischaMes & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t$No ❑ NA ❑ NE
❑ Yes
❑ No V NA
❑ NE
❑ Yes
❑ No
f NA
❑ NE
ONA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
❑NA
[I NE
12128104 Continued

Facility Number: .
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes ''No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ONA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / 9 _� '
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
IgNo ❑ 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
_AVo ❑ 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
t50slo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
PCA
❑ NA El NE
maintenance/improvement?
�No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA [INE
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence ofWind Drift [I Application of Area
�Outside
12. Crop type(s) cm`.r� a �S/
_S {� , _C.- . &..,j. �"�ot --
13. Sail type(s) �P-�-,� -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 acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
T No
❑ NA
❑ NE
18. 1s 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+any other comments.
Use drawings of facility tobetter explain ;situations. (use additional pages' as necessary)
! /t a +E'., s ; �,•r`�"., 82. ..� _+4'§ fit¢ �s
Reviewer/Inspector NamePhone: -3 3t0
Reviewer/Inspector Signature: Date:
12128104 Condinsted

Facility Number: F— Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �VNo ❑ NA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E92INo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes -0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ggNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
y�,�
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
0No
❑ 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
ISNo
❑ 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
12128104

Division of Water Quality
Facility Number 3 0 Division of Soil and Water Conservation
Q Other Agency ,!
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:qTU
Arrival Time: `^'lam Departure Time: /a' Mi?h County: �� Region: r ' "
Farm Name: i 1 1 �1oL N POT Owner Email:
Owner Name: T)a0I'JW. Sun"i/4y1 Phone: (/0) 9 rQ 7-20/Jr
Mailing Address:
Physical Address:
� JJ.
Facility Contact: V1_- __ 5�f'(! vary Title: Phone No:
Onsite Representative: I( Integrator: /�
Certified Operator: tl Operator Certification Number: 1030__
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =e =' 0" Longitude: ❑o=' =��
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
��� y�l ❑ Non -La et
Dry Poultry
Non -La
Pullets
Poults
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity i'opulatlon,.;��`
is
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes to No ❑ NA ❑ NE
El Yes El No NA
[I NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
El Yes �No El NA
El NE
❑ Yes No ❑ NA
❑ NE
12128104 Continued

,•• F eility Number: r7 — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No On NA El NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
rr
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1P 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
� No [I NA ❑ NE
$. 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
0 No ❑ NA ❑ NE
maintenance or improvement?
ff
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
I�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Window ❑ Evidence of WindDrift ❑ Aepplliic-ation Outside of Area
�A-c_c�eptjabrlle,Crop
12. Crop types) (tf gS7 r +►'� a "t7S5 �l'{ � sM [N�L.t•• i�t 'Sf�
13. Soil type(s) A Lleea pp
z
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
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
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
[P 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):
S I LJ� Q ,5 Gi.✓� S 4
r �I
,�,y. e- �� �
AL
Cal.i6vaUyx kas bah
.
ca (�W-
Reviewer/Inspector Name
j�jPhon
Reviewer/Inspector Signature:
Date: !l D
12128104 Continued

Facility Number: — Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ 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
ip 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
VI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
SNo
❑ NA
❑ NE
Other Issues
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
F 9 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
P 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
§D No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
r No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
91 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Fpp
Date of Visit: '�S�f� Arrival Time: :�$ ar. Departure Time: o: S County: tC�7 ia C�}I'ri0+'L Region: ,l�
Farm Name: ) Owner Email:
Owner Name: D2 V id Sit l l VQ Y1 Phone: Cg'���g ! - .2ol s-
1 �
Mailing Address: � �—� W
G
Physical Address:
Facility Contact: V i s Su 1 l 1 Vah Title:
Onsite Representative:
�I
u
Certified Operator:
Back-up Operator:
Phone No:
Integrator: T {� Luri 15
Operator Certification Number: 19330
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = id Longitude: 0 ° ❑ i 0 "
Design GUMent
Swine Capacity Population
❑ Wean to Finish
Design Current Design C►►arrant
Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
3
Dry Poultry
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Gilts
El Boars
(7thar
❑ Other
El Beef Feeder
El Beef Brood Cowl I
Number of Structures:
El Pull
❑ rke s
Tu❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑Yes ®No ❑NA ❑NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
® NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

r , 4
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: I
Spillway?:
Designed Freeboard (in): A4to
Observed Freeboard (in): 3q it
❑ Yes F No ❑ NA ❑ NE
❑Yes ❑No V3NA ❑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 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 [A No ❑ 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 N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5Z 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) 15Prr 1tkda �40t . 5 Mai ( GV.CLtih
13. Soil type(s) & 6 f - _._..----
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
['No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
�.R
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):"
tJa.s TW(Y `os ,
`
Reviewer/inspector Name Ro6e j Phone: 10) 1_4 3--3-3300
Reviewer/Inspector Signature: Date: ,b
Wage z of 1 12128104 Continued

;� . .
Facility Number: I I — L3 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5�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
EANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
t@ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
1520 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
❑ No
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
[A 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
[A 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
X 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
A� y _Y. ? '�.k,f, t W`� 1�`f�'sa°� �"�d9�;� ,,,p a ���p„e. . cp i s
ilildltional Cotn►nens-;andlor'Ilrawings k:i� ,d �F�%7 . i' &' s
q, CP,r44 cak v4-' C&o %L4 a rit> — co-h 4ble.) Cold CDC oe, , 2-00qj
�.¢Xvw`t r�newo►� (QG��- Caron was a,�'`�q���,
Wit( Atck ov, sus [ r"_k\,,, o4-' coc 144,er,
12128104

Facilit•• lumber Date of Visit: 4i? D Time:
=Not Below Threshold
® Permitted ® Certified E3 Conditionall-s• Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ,S. La 11 i q G,n a u_Lj rL, County: .i C�n,�n
Owner Name: � �i[a A� �IC�n ._ Phone No: _ 10 c1C, i'" — tot
N1ailing Address: 34,1, I_i,3,QQQA�,..L.v.e �o� ,n� �', , a $37-rr
Facility Contact: .ti A S L4k i0 Gv. Title: Phone No:
Onsite Representative: Integrator: _ Pt'w. < _
Certified Operator: A7,"; c4 Su. � J� ✓� Operator Certification Number: 1 g,3.,3 0
Location of Farm:
®Swine []Poultry []Cattle ❑ Horse Latitude ' ° 0" Longitude ' 1
Design Current Design Current Design Current
Swine Ca acity Population Poultry .Caoaicitv Pollulation Cattle Capacity Po uladon
❑ Wean to Feeder IQ Laver E
Dai
Feeder to Finish 3 ❑Non -Laver Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
I0 Subsurface Drains Present j10 Lagoon Area J0 Spray Field A
F - ' ❑ o Liquid Waste Mana ement Svstem '
Discharges 8-Stream is
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Laaoon ❑ 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 D WQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & IreglMent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes [P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ® No
Structure 6
Continued

1 •�
Facility Number: jj— _ 13 1 Date of Inspection
5. Are 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? (If any of questions 4-6 was answered yes, and the situation poses an ❑ Yes R'No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [ZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Wo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
['P No
Was(.f Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Callo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
PjNo
12. Crop type t �_� td,c M-- , eyjL_� (ir-e 1 n Q,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
4No
16. Is there a lack of adequate waste application equipment?
❑ Yes
Q No
Readmd_Records &documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[53,No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
I'M" No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[ZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
qNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[Q No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
"No
24. Does facility require a follow-up visit by same agency?
❑ Yes
IMNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
01 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
•omments (refer to question #); Explain an YES answers andlor ny recommendation or an other comma s.
Use drawing of facility to better explain situations. (use ad itional pages as necessary): ❑ Field Copy ❑ Final Notes
4 -n.1
Reviewer/Inspector Name r
Reviewer/Inspector Signature: r,Date:
05103101 ' Continued

Facility Number: — 13 1 Date of Inspection
Odar LUAU
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?
OS/03101
❑ Yes ❑ No
❑ Yes [�4 No
❑ Yes @ No
❑ Yes P No
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No

Date of Visit: 0 03 Timc:
L __ - I IQ Facility Number
Not Operational 0 Below Threshold
® Permitted ® Certified Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: &.r - 20 L�Q -r[� County: .Lg' _,
Owner Name: .D1..1 r.��l,J, Cu Phone No: m
Mailing Address: _ 3 a L.l '-LA O e d, e, clt_ kyu�,8, �
Facility Contact: Title: rrt.r.- tI- Phone No:
Onsite Representative: ' � d S u Lt iye , Integrator:
Certified Operator: 6.u,)-cL SU_C(,,UG..r, Operator Certification Number: P330
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 u Longitude
Design Current
Design Current Design Current
Swine Ca aelty Population
Poultry
Capacity Population Cattle Ca achy Population
❑ Wean to Feeder
❑ Laver
I
I
I
Dairy I®Feeder
to Finish
A 2-S .
❑ Non -La er
El
Nan -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area'
(=Holding Ponds / Solid Traps 10 No Liq uid Waste Management System
Dischorges & Stream, Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav 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 gaUmin?
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 & TuaMient
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes ® No
❑ Yes Q No
Structure 6
Continued

a
Facility Number: — IS Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes allo
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 [3No
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 A earn LxAf. .(""U RA AS .
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 [D No
16. Is there a lack of adequate waste application equipment? ❑ Yes [9 No
Reauired Records & Documents
17, Pail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 111No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes R No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0 No
24. Does facility require a follow-up visit by same agency? ❑ Yes 50 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [19+lo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
g-q( q �$ ) ,_ p.r nay s_ y$ , n ,Dr, any n h §comments
Comments refer to uestiori # Ez lain an YES answers;andlor an recommendations.
#Use drawings of facility to`better explain situations. (uscailditinnal.pagwas necessary). Field Copy ❑Final Not
�G m G- $o-av\, 4- r sc o r-Ot0 fb' a tt-fv�`y -
L
Reviewer/inspector Name ;..
Reviewer/inspector Signature: Date: G3
V
O5103101 Continued

f Facility Number: w- (a I Date of Inspection 0 S D
Oda 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?
05103101
Giles R[No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes [d No
❑ Yes No
❑ Yes ❑ No

Facility Number Date 01' Visit: d Time:
18 Not O erationa elow Threshold
Permitted ■ Certified 0 Conditionally Certified ©Registered Date Last Operated o� A4ov Threshold:
Farm Name: �/ �✓� County:��
Owner Name: �v Phone/No:
Mailing Address: _ ��zl/!J6.�QO ��y,J,/•"' /!/i.•-� %�� i� _ A?-7 %
Facility Contact: i-¢�a'/ _1 G� /yA� Title:
Onsite Representative:
Certified Operator: DW,�
Location of Farm:
Phone No:
xV . G- i .�Vkt
integrator: .f�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0" �• 0" Longitude • • 0-
A:Design ., -Cu
Swine, Ca acit�;,.`Pti a
Wean to Feeder
Feeder to Finish
-'❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
(] Gilts
Boars
3
Number, o[ LagoonES! E
Holdiiriw onds`'kS61id1Tr40s
, ,,Design Ei,Current , Design Current
,} <Poult�. E. '.Cu`acity `Po`ulation� ' `Cattle `a'civ Population
❑ Layer ! (I Dairy
1 ❑ Non -Laver I ❑ Non -Dairy
, W
❑ Other II
N Total Design Capacity
,Total`Sk
Subsurface Drair
No Liquid Waste
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):,
05103101
;prav Field Area
❑ Yes R No
❑ Yes f No
❑ Yes &No
❑ Yes
R No
❑ Yes
JKNo
❑ Yes
;&No
❑ Yes P No
Structure 6
Continued

Facility Number: 77 — j3
Date of Inspection 0
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
I0. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑/ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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/ WP, chefklists, d !!gn, m�s, etc,) ✓ —1-11
19. Does record keeping need improvement? (ie/ irrigat on, 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 XfNo
❑ Yes RNo
❑ Yes R No
❑ Yes KNo
❑ Yes P�Tio
❑ Yes RNo
❑ Yes XNo
❑ Yes ZrNo
❑ Yes ANo
❑ Yes No
❑ Yes 15iNo
❑ Yes KNo
❑ Yes KNo
❑ Yes XrNo
❑ Yes KNo
❑ Yes JkNo
❑ Yes f5No
❑ Yes KNo
[:1 Yes U] No
❑ Yes MNo
❑ Yes R.No
❑ Yes 25No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (r'efer to guestlon',#) Explain any YES`aoswers;and/nr any'recomraeai3ations'ar any:other 6M' imertts.'
i3sc drawln i�'Ufstcili to better explain,situations:;(use ad fitianal pages as necessary) '.'I❑ Field Copv ❑ Final Not
g ty
J
A)10
Reviewerllnspector Name '
Reviewer/inspector Signature: Date: 2 DZ
0510310I Continued

Facility Number: 7 — ,(J Date of Inspection D?
dor 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 N 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 M No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
tAdditional Comme'ntsand/ornllrawings. <',", �,E'.i.., z it t=;9E�.�` €•_�._"; 3 u7�. =all �3,. .1P' �.
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05103101