820108_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

(y,k s
�, 1 kb it �'' �I ' I " f i �' kr k' ivislon of Water'ResOurces
-ilk �� ' ul 1ki� - {� x ' 1 -
Ili{Facility` Numbers--t1� + 0 Division of Soil and -Water Conservation:
0OthAgen
er_cy
Type of Visit:^ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: t� xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r pct Departure Time: County: S wi RegionF
Farm Name:I'y Liw—cr,-5 1 /�7� Owner Email:
Owner Name: VI tr ti 5 Phone:
Mailing Address: '
Physical Address:
Facility Contact: �1� l�ri/1t dCsy '� Title: Phone:
Onsite Representative: r Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
w
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
,' Other
k
Latitude:
Certification Number:
Longitude:
ent Design Current
p °' �� "Wet Poultry Capacity, Pop Cattle
, I r.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
' 'Design Current
n— u..,.if.
Pullets
v Turkey Pou
1 1Other
Design Current
Capacity Pop.
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0,NT-_0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [D -MA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No [.-}A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
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
E3 NA
❑ NE
❑ Yes
['IGo
❑ NA
❑ NE
❑ Yes
(No
❑ NA
❑ NE
Page 1 of 2/4/2015 Continued
N

5lFacili Number: - b Date of Inspection:
4este Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ahfo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ®NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z%
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q-1q'o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[;>o
❑ NA
❑ NE
waste management or closure plan?
[a'No
❑ NA ❑ NE
the appropriate box.
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
ErNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E;,No
❑ NA.
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ 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
9. Does any part of the waste management system other than the waste structures require
❑ Yes
<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q 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): ?10� P C'r "` 5 (' 0
r
13. Soil Type(s): t �
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Callo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [3 Yes E]"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes D—No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ONo [DNA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3'No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a'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
ETNo
❑ 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
�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [5No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacilitir Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [EI -N-0
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 provide documentation of an actively certified operator in charge? ❑ Yes ❑'<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Vo
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 the 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes ❑4o ❑ NA ❑ NE
❑ Yes 5g4o ❑ NA ❑ NE
❑ Yes ❑�<o ❑ NA ❑ NE
❑ Yes P<o ❑ NA ❑ NE
[] Yes' [31�o
[:]Yes [ No
[:]Yes []`fo
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Cbmmerits (refei tb;questian #.) . x'laln an° Yl;S�answers andlbr.'an additiorial"'Fe-6m neridations,b"rfan ;other comments:
Use drawings,of:facility to,.better:.ex lain situutior<s;.{use additi_onah _agestas;nec"Asa
r- ,). =
I3 -17
-s-,v
Reviewer/Inspector Name: _is
� 111E t,.j�{�� Phone - TCL 1�'333�
7�Reviewer/Inspector Signature: 10 Date 1
Page 3 of 3 21412015

i
(31 M slon of Water Resources
Facility Number ®- 0 Division of Sol] and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 42rkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: d[� County:
Farm Name: -ff--/ g - Z Owner Email:
Owner Name: t�f.�j Phone:
Mailing Address:
Physical Address:
Facility Contact: Fv �ttl1 Lim Title: Phone:
Onsite Representative: i� Integrator: , Vt
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
can to Finish
can to Feeder
leder to Finish
Lrrow to Wean
grow to Feeder
grow to Finish
Boars
Other
Other
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[Layer
Non -La er
Pullets
Other
Poults
Design Current
Longitude:
Region: F
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ff NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [?'AA ❑ 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 FrNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EZ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facility Number: 6j, - Kate ecti
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cg-Ko"� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No [2KA ❑ 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 Ga"]-' ❑ 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 CfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E�FNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
Vo
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
P:�Wo
❑ NA
❑ NE
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Vo
❑ NA
❑ NE
maintenance or improvement?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
G-
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. D Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [3Application Outside of Approved Area
12. Crop Type(s): CW 9 ev wt"k 9614 4?6D
❑ NE
13. Soil Type(s): (,(
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;30<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Plo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�Io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ 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:�Wo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
G-
E:] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9"V
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

IFacilk Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [3—W ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [.Alar ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a AOA 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)
[]Yes
NA
❑ NE
[:]Yes
GP�Nlo
❑ NA
❑ NE
❑ Yes
[D -No
❑ NA
❑'NE
❑ Yes EjJW ❑ NA ❑ NE
[:]Yes [D�Ko` ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Ca—W
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes C] No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [_io
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question 9): Explain any YES answers and/or any additionhl.:recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages.as necessary).
CAA&4-c-u r � e--�s
�2 263
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `"l 3 -, 33
Date: 3(&L�A
2/4/2014

els 1 Is esu
Division of Water Quality
Facility Number L._iL�J - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: om "lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit; Arrival Time: Departure Time: DU County: c�
Farm Name: Y LuGti-8 Owner Email:
Owner Name: A.e41y[.4 P.s Phone:
Mailing Address:
Physical Address: r`
Facility Contact: i� Cl cln { SQA.-�-r Title: Phone:
Onsite Representative: `r Integrator;�
Certified Operator:
Back-up Operator:
Location of Farm:
q
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish UTS d
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream Imuacts
Region: f ' y
Certification Number: 16711,Y
Certification Number:
Latitude:
❑ Yes
[n -Ko
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Wet Poultry
Design
Capacity
Current
Pop.
La er
NA
❑ NE
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
Non -Layers
❑ NE
Pullets
Turkeys
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Turkev Poults
❑ No
A
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
[n -Ko
❑ 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
❑ NoEYN-A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[Zj,<o
❑ 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 F2/412011 Continued

Facilit Numbef: -_j Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑_d6 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑'NSA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):a�
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 M No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
to ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D_�o NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑.No ❑ NA
❑ NE
maintenance or improvement?
��o❑ NA
❑ NE
the appropriate box.
Waste Application
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Io ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes { i No ❑ NA
❑ 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, IW/indoowe E] Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): e eu w(� C uuB
13. Soil Type(s): kJ
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�< ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F3'<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
Ej<oo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5110 ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3 -Ko ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
��o❑ 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 allo ❑ 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 �o E] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Numbet: - Date of Ins ection:
io
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Cg 1VU
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
2<o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -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
[DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C�,W
❑ 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 E2 -lo ❑ NA ❑ NE
❑ Yes J2 1Go ❑ NA ❑ NE
[:)Yes 2<o ❑ NA ❑ NE
❑ Yes ZeNo ❑ NA ❑ NE
❑ Yes
io
❑ NA
❑ NE
❑ Yes
�io
❑ NA
❑ NE
❑ Yes
Q o
❑ NA
❑ NE
Coents: refer to iestion p
qY
i # Ex lain an 3YES answervand/or "any additional reco�hmendations or hny other comment
mms°
. . ,.
Use dra'Wings.offacill to better explain situation's (use additional ages'as necessa. _):.
C.('6VICt'4� ' I - �k__ I S
Reviewer/Inspector Name: Phone: q3 J J J
Reviewer/Inspector Signature: Date: }
Page 3 of 3 21412 b 14

Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: QfRoutine O'Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: Countyt.PA fC,,
Farm Name: _ T� �.�c,rae _�"'�{ �� Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title:
Latitude:
Region:
Phone:
Integrator:
Ig T�
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ffNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E]rNA
❑ 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
6NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit Number: - Q s ection:
(ante Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
iVo
❑ 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
0 NA
Identifier:
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
Designed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
Observed Freeboard (in):
Required Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E?�`No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[Vo
❑ NA
❑ NE
waste management or closure plan?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑/No
❑ NA
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
ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
9. Does any part of the waste management system other than the waste structures require
[D Yes
Eno
❑ NA
❑ NE
maintenance or improvement?
2/4/2011 Continued
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
ffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E]e o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window n _❑ Evidence of Wind Drift C] Application Outside of Approved Area
12. Crop Type(s): - " +QL] E"i'�'�[. fS ij o !f�
13. Soil Type(s): I
14. Do the receiving crops differ Mom those designated in the CAWMP?
❑ Yes
[n -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
dNo
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists []Design ❑ Maps E31 -ease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking p Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Er/No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Faci i Number: - Date of Inspection:
Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes B<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'G�_ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
0 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 io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2<o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ 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
EJONo
❑ NA
ONE
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
2 "Co
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [] Yes❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? EDYes eNo ❑ NA ❑ NE
1C
Comments (ref6r to question,#) Explain any YES answers and/or- any additional ttecom mendatians ore any�other4'coiimments
�3
# � .: .,
Use, dr"awings;;af facili.ty'ta.better cxp
lain sttpaYiaris°{use�a'dditionai`ages�as necessur) ..�=� .�. ,�����,��,��,
_,Q_— l-
q-( U
3e �—S 0 q,7q
Reviewer/Inspector Name: c Mr 14
c
Reviewer/Inspector Signature: RIA Date: f
Page 3 of 3 2/4/2011

Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit:Com liance Inspection Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time c County: f �
Farm Name: f T t0 iid`V Lt-[. 'f (¢ �� Owner Email:
t
Owner Name: Phone:
Mailing Address:
Physical Address:
Reglona
Facility Contact:Ph Ilk'7/' �Sv Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: /1113
Back-up Operator:
n 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
`Certification Number:
Latitude:
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
F;LayerNon-Layer
Non -L
Pullets
Other
Pou
Design Current
Longitude: _
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEX Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E5 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) []Yes ❑ No [ENA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes [�'w
❑ Yes �io
E f NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 2/4/2011 Continued

Facili Number: Date of Ins ectiow.
Waste Collection & Treatment �d'�O�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LL ❑ NA ❑ NE
a. If yes, is waste level into the structural frceboard?
❑ Yes
❑ No
[[] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E <-
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
I_E4
❑ NA
Designed Freeboard (in): 1150
acres determination?
Observed Freeboard (in): —-
17. Does the facility lack adequate acreage for land application?
❑ Yes
FLKo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R1<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
03 -Ko'
❑ 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
E214o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;PNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0311go
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q>o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q,No ❑ NA
❑ 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):
00
13. Soil Type(s): __k) groRAM
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'Z
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E <-
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
I_E4
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
FLKo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �o [DNA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes CE 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 Eke o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 02 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3,4o ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Ins ection•
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3*No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FEK0 ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Cpl<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
[:]Yes
[ Io
❑ NA
❑ NE
and report mortality rates that were higher than non -nal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[R/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
02 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
[gNo
❑ 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 [D"No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [E/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).
cct(�Wv-�- �� �7- Ly
Jar
Reviewer/Inspector Name:
r� '0'C T /S-02
Reviewer/Inspector Signature:
Page 3 of 3
t
Phone A` 333
Dat
2/4/2011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:7j j12 j Arrival Time: i1 Arl Departure Time: County: Region: rR V
Farm Name: x''g��r„�� 4zoa Owner Email:
Owner Name: i., �C s Phone:
Mailing Address:
Physical Address: Sj�00 %
Facility Contact: Title: Phone:
Onsite Representative: �p 1�� fl C9A1 jD 2 firl*J_ _ Integrator: M�+ �h�t _ zRC M .3N
Certified Operator: Q 60 Certification Number: tq 11'`5
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
ESwine Capacity Pop.
Wean to Finish
Wct Poultry
La er
Design
Capacity
C►urred
Pop.
nt
Design CHP,
Cattle Capacity .
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
If Feeder to Finish 11 3�
Farrow to Wean
Farrow to Feeder
Dr, P,c�ultr,
Design
C►_a aci.
C_U_rrent
P,o ,
Dai Heifer
D Cow
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Othe
Other
Turke s
rkey Poults
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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?
❑ Yesvy/No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
[:]Yes ❑ No
[:]Yes 9No
[:]Yes 9No
NA ❑ NE
r;'lA ❑ NE
[g/NA ❑ N E
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

Facili Number: Date of Inspection: *7151.113,
❑ Yes
[S�-No
[] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Waste Collection & Treatment '
F!�INo
❑ NA ❑ NE
the appropriate box.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�J`No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E!rNA
❑ NE
Str+�ucttu�re� 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Identifier: J ]. ]O 03 Ila
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�rNo
❑ NA ❑ NE
Spillway?:
❑ Yes
❑ No
CS]�NA ❑ NE
Page 2 of 3
Designed Freeboard (in): Ct
2/4/2011 Continued
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[VNo
❑ 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
CyNo
❑ 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
gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
[ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
2"'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [E(No ❑ NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > l0% 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) ASIA\ �L tRtnL�Uo 1�1A.� I e'� . �. G • C ch(ir� L'V'L'.. 2%.A b,P`9hs
13. Soil Type(s): 4�.d
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [1'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[]Yes gNo ❑ NA ❑ NE
[:]Yes Ev(No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[S�-No
[] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F!�INo
❑ 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.
E]Yes
dNo
❑ NA E]NE
F-1Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CS]�NA ❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number: - O Date of Inspection: `1
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? 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:
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
® NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [7 No ❑ NA E] NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
[2] No
❑ NA
❑ NE
❑ Yes
g] No
❑ NA
❑ NE
[] Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: - 7131
2/4/2011

OW JUS` 1611(1 11
� Di'vi'sion of Water Quality
FaciiiGy NPWNFA
umber Division of Soil and Water Conservat€an
oQ Other Agccy
Type of Visit: 6 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (2� Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:pS�
Farm Name: Ptnrw Lpe-4i F&m w am(P,, Owner Email:
Owner Name: genng ZLLa]- Phone:
Mailing Address:
Physical Address:
Region: J
Facility Contact: Title: Phone:
Onsite Representative:h j �€A .PIIS T Integrator:
Certified Operator: 1-') �'� �GY]dpr�ID� Certification Number: 4113
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
❑ No
Design
Current
Design Current
0 No
Swine Capacity Pop.
Wet Poultry
C►apaeity
Pop.
C•uttle Capacity Pop.
❑ NE
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I JNon-LaycrDairy
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P
Non-Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Ca No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
Ig No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: a. - Q Date of inspection- '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F�g] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
[5? No
❑ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
f5; No
❑ NA
❑ NE
[—]Yes CErNo ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes [RNo
❑ Yes IgNo
[]Yes 6t—
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer t6'question #):`.Explain ahy.�YES answers and/or any additional rccommcnd�i'tionStorran .other comnien'is.
Use drawings of facilityto better explain situations (use additionAl pages s necc saiy).; yss, y x
add- ieso" I SOMMIOP11916u sem. J and lracy on +or q -sI" 67(a Jaymr»
a 35�p a)d- ba -esu nfPr rnark�r al 149oo-7 a oy? , 'Pl,eas e 1� ow s lo�r
Sall Ai e +h OT �a J J,
;D1, wojiesanflej CV-'eqpOCL ` 60 d'ay p�ec�e �e�-s �►le Ev#-�• 3--q rnas,
S -e vea I ev# 1i. wefe-V 1 rr�'9a W d vi oL - waaie jC a�O Ih Pe b, j dr
I � � FdV i -)#-q. I Ne IVA b� COPS,
(q+as noted. obove� riefkmaok1 �, ordel61,i 4r e (Drdj.,
Reviewer/Inspector Name: Phone: 33pQrjj{t1°�
Reviewer/Inspector Signature: %Date:
Page 3 of 3 2/4/2011

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 ❑ 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: meq_3� SO
Spillway?:
Designed Freeboard (in): Iq1 �.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
15'No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
$.No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fo No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
Waste Application ❑ Weekly Freeboard E Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
9. Does any part of the waste management system other than the waste structures require
❑ Yes
J:R No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
Waste Application
[2-jNA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
���
12. Crop Type(s): �l LTL_: [_�_Qfdl�1 1� wised , Carl
� •a--
13. Soil Type(s): yL r V
„,-•---•--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
f5j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
12 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
f�,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1.�2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ERNo
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
$.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.
MYes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard E Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[51 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
❑ No
[2-jNA
❑ NE
Page 2 of 3 2/412011 Continued

Facility No. j2ZLLZ._._Farm Name AOA i, v L Date
Permit %---'COCr� 01C NPDES Rainbreaker PLAT Annual Cert
Pop. Design Current
TVDe
,34Y
C7i7itr AIY1l
w
�r� T.ayA
r'�u .r�rr1
Lagoon 1 2 3 4 5 6 7
S illwa
Design freeboard
Observed freeboard in
Sludge Survey Date l da
Sludge Depth ft
Liquid Trt. Zone ft r
Ratio Sludge to Treatment Volume
Calibration Date 1 2 3 31 4 5 6 7 B
Design Flow 11b, W
Actual Flow IF
Design Width p 0
Actual Width
Soil Test Date 114,V, Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed Weekly Freeboard Mortality Records ,J
Lime Applied 1 in Inspections la13d
Cu -I Zn -I 120 min Insp. P a
Needs Weather Codes +�
Crop Yield T ansfer Sheets W f , dol?a 1
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt Ib11000 Gal 4
H
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date
, last WUP at farm
FRO or Farm R ords � 11' ��Da
" ' e—
Lagoon # '05u a3'fq
Top Dike la
Stop Pump 10T`3
Start Pump x+013
Conversion- Cu -I 3000= 108 lb/ac; Zn -1.3000= 213 Ib/ac
�+`Co��S�o��
1WApp. Hardware
Q34R- 0-,0o4111CW
*(tei ne'-m

f bIR3 1) 1100
Facility Number $'
§i Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
IType of Visit I%ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason far Visit 6rRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit[ Arrival Time: Departure Time: �i,� County: Region:
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
LVC0r Phone:
Physical Address: f'
Facility Contact: ROiLip
� �Title: ©Phone No: @qk2 q3
Onsite Representative: Nifa sd&FQ3integrator: I' D
Certified Operator: `1 l y � `�1�d'? Operator Certification Number: R1
Back=up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 =i
=61
Longitude: = ° ❑ `�
Swine
Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ l3oars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer —Ell
Other
❑ Other
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: W
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 tgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
5 N
[I NA
El NE
❑ Yes
[SNo
❑ NA
❑ NE
12/28/04 Continued

f Facility Number: — IM I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5JNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes DjNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No �JNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
UIo
❑ NA
❑ NE
25. slid the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
UNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
&Q -No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Q�NA
❑ NE
Other Issues
p)ee5e- M e, o(d row,, huh► ba10 � -field. S&ne DPI,ee rel he-
�� .gyp vl� ) a j t� ba,'Ars -Por hA I d, Fcmfl L imlp d ofe_ by 6 ps •
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
IRNo
❑ 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
CgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
rKrNo
❑ NA
❑ NE
Additional Comments andlor:Drawings:
cw
-7, ��no� Yvak on bxe, s a� bo, kse a34q, I+Wax 0v4-3tcwd ontopjfvHI
I h bei 17v�'r�'J
P(:P S
�ra�s ��aPyr Soli saN� � g ole o wok � �
oo 4t bot , 0--e mew bades .3 SD
p)ee5e- M e, o(d row,, huh► ba10 � -field. S&ne DPI,ee rel he-
�� .gyp vl� ) a j t� ba,'Ars -Por hA I d, Fcmfl L imlp d ofe_ by 6 ps •
�t Slvol suNP doraofo wasdoke bu+ has )lb+ b"� Yy� d �� yep, aooq
s 1�7eWm cy2� 5 c rtga m�i�- Vol��r�,
5wv� j
&#V1I v -2r yvel I ma *m Oldpak rl°ccrdr.
Page 3 of 3 12/28/04

12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Facility Number: — log
Date of Inspection
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J�}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: 3544 13SV
❑ NE
Spillway?:
Designed Freeboard (in): IQ Igt15-
Observed Freeboard (in): oZ
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?
$j'Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1�7No
❑ 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 FINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Wo
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[5kNo
❑ 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
CRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
L -J`' No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5JNo
❑ NA
❑ NE
Comments (refer fo.quest�on #) Explain any YES;answer."s and/or anyreco�mtm.endationsoran other commen#s a r
Use drawings of facility to better explain situations.�(use addlhonit pages asjnecessary) . �, i y
., A <... .t;
Reviewer/inspector NameQMA
f �'-�/€-� ----- ':i Y 4 x
- - ,` Phone: [phone]A90,33Reviewer/Inspector Signature: _ Date:QV_Q, aQ��
12/28/04 Continued

• =FaNity No.
$ rrOy
Farm Name
Lix0
Date III A10
Permit
COC
✓
OIC_
NPDES {Rainbreaker PLAT Annual Cert )
Pop.
Type
Design Current
D e sign Flow
- •
,N1
Design •
0`/ I I -��---
�j
FB
Design fr- - .... sludge --_----
Observed freeboard _(in)
Sludge Survey Date
Depth (ft)
Liquid Trt._Zone (ft)
R,atfo Sludge to Treatment
i1-,iRgtM+l1!RllIN N"079A■
Soil Test Date,Wettable Acres RAIN GAUGE
pH Fields _ WUP - L7 Dead box or incinerator
Lime Needed Weekly Freeboard— Mortality Records
Lime Applied 1 in Inspections
Cu -I In -I 420 min Insp. ✓
Needs P �Q� Weather Codes ✓
Cron Yield / Transfer Sheets
N Amt (lb/1 000
nmmn=• • • • •
A7 ii ;mit NVA1► �! +� + '
D e sign Flow
- •
,N1
Design •
0`/ I I -��---
Actual Width
P-11 i
Soil Test Date,Wettable Acres RAIN GAUGE
pH Fields _ WUP - L7 Dead box or incinerator
Lime Needed Weekly Freeboard— Mortality Records
Lime Applied 1 in Inspections
Cu -I In -I 420 min Insp. ✓
Needs P �Q� Weather Codes ✓
Cron Yield / Transfer Sheets
N Amt (lb/1 000
nmmn=• • • • •
A7 ii ;mit NVA1► �! +� + '
���
Verify PHONE PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
App. Hardware
1011P�a3w

h
9_T44 fl -OZ -7-630117
Type of Visit O -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: O 30 09 Arrival Time: O,'!�d Departure Time: �a�'Ol County:Region:
e
Farm Name: �/e_ovr+a Lreee-j �4r�*-+ � �Z _ Owner Email:
Owner Name: _ _ #4^Iry L u ria Phone:
Mailing Address:
Physical Address: 11
Facility Contact: -.-A r! ll "Af Title: r Phone No:
Onsite Representative: �!���o ��"�� �� Integrator: � 4 4?1VZ.Z^/ _
Certified Operator: / �1��}�` "' °�' `�5� Operator Certification Number:
Back-up Operator: I Back-up Certification Number:
Location of Farm: Latitude: =0
=6 =11 Longitude: =0=' =
Design Current
DesiWnrentDesign
CurrenSwine
Capacity Population
Wet Poultry C*opaation
Cattle C►opacity Fopulallan
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ can to Feeder
❑ Non -Layer
❑ No
0 Dairy Calf
IR�Feeder to Finish %
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
La
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
:1Boars
❑ Pullets
❑ Beef Brood Cow
O No
❑ Turkeys
❑ NE
Other
❑ Turkey Poults
No
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
EJ,5A'
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12/28104
Continued

I .y
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�o ❑ NA ❑ NE
Facility Number: 2 — Date of Inspection
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Waste Collection & Treatment
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
Reviewer/Inspector Signature:
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElTJ Yes
,�
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ETNo ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
``
Identifier: 1.3 �91 231570 `3)
No El NA ❑ NE
Spillway?: 4 A10
15.
Does the receiving crop and/or land application site need improvement?
Designed Freeboard (in):
,._,
�'1Vo ❑ NA ❑ NE
L��O�_[]
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Observed Freeboard (in): 3 35
NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
e<o ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
3<o ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
B_N�013 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
} qoo [] NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
LlI� Yes
,[-i
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
,�.�
LI �o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E<o ❑ NA
❑ NE
maintenance/improvement?
11,
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Name
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
Reviewer/Inspector Signature:
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside ofArea
12.
Crop type(s) �e►7Ktc a� �fi`/craCl trg�.v �O.S,' e:a11A1 44t�t'r"
13.
Soiltype(s) A -LF>
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No El NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
,._,
�'1Vo ❑ NA ❑ NE
L��O�_[]
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
3<o ❑ NA ❑ NE
,,t tete , r
Comments (refer to question #): ' Explain any V, Es answers andlor any!rccommenu ationa, any other comments
Use drawings of facility to better explain situations. (useladditional pitgesyas necessary) i
-
Reviewer/Inspector Name
!` . / j't g 1 Phone: ��O.3�33,33d a
Reviewer/Inspector Signature:
Date:
12/28/04 Continued

Facility Number: /08 Date of Inspection
Required Records & Documents ,_,,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 3 Na ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LTNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L7No
❑ NA
❑ NE
No ❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Yes
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10
[INA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�
LSNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N/o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
3 o
❑ 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
is
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I3'No ❑ NA
FINE
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
A
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
o NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o ❑ NA
❑ NE
12/28/04

6 fkS �1�tog Ovf
' Q'Division of Water Quality
Facility Number ga Q Division of Sol! and Water Conservation
Q Other Agency
Type of Visit (-PfCompllance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CRoutine O Complaint 0 Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: �ti Departure Time: 11"YIPM I County: 64"Po Region: _fP20
Farm Name:�fNj 4yC,#J G,/—* 1 44a Owner Email:
Owner Name: Lucas Str Phone:
Mailing Address: p '06 New An e a ab RL I uv key
Physical Address:
Facility Contact: Title:
Onsite Representative:S
Certified Operator:�� f�
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
Phone No: D26— 7113/
Integrator: M`1;nn
Operator Certification Number: ? R 3
Back-up Certification Number:
Latitude: =0
=I
=41 Longitude: = ° = i =61
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
Cl Yes
El No
[]Yes
CKNo
❑ NA
EINE
❑ Yes RNO ❑ NA ❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: Opj=
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?
avo Structure l Structure 2 Structure 3 Structure 4
Identifier: 3
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 32 3.s~
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure pian?
❑ Yes 1!;kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes TgNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [RYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [&No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �d No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N'No El NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) VIld1I� vdLI l f},; SCQ of it cbrn. )VheA SQVhenJ
13.
Soil type(s) Wa D l S
Reviewer/Inspector Name Phone. q10 433 3309x'3333
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CRNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
d Yes
I'No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[FNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
C'No
❑ NA
❑ NE '
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
JR -No
❑ NA
❑ NE
tComments ("refer o,questlonK#) Explain`�any YES answers and/or any recommendations or any other comments.
,. �,� :.�:; �� v ��v�s
Use drawingoffac€illy,tahttkxpiainsitua b,�ns. ���s�d dlti„o�lpa�ges as necessary};
Reviewer/Inspector Name Phone. q10 433 3309x'3333
Reviewer/Inspector Signature: Date:
Page 2 of 3 V 12/28/04 Continued

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
9No
❑ NA
Facility Number: Date of Inspection
25. Did the facility fail to conduct a sludge survey as required by the permit'?
[:]Yes
(RNo
Required Records & Documents
❑NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
5JNo
[INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5�-No
❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design El maps El other
❑ NA
❑ NE
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 I"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
fgNo
❑ 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
9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit'?
[:]Yes
(RNo
[:INA
❑NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
12 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
12 NA
❑ NE
Other Issues
back i�) -he_s;de,s.
GoaL r,ec&d.s,
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
19No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
t'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
ONo
❑ 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
'RNo
❑ 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
DTNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fK No
❑ NA
❑ NE
Additional Comments and/or Drawings: k
-7, �f'eff ba e orj, ��p d s�o'i s on 1 joaj.) esredi?
is, LIMB ItiQr Is S V;1V7
beets az a b x�- a �M 1ha�al. Plan f off,
Ail The
Di vej; e9rQ'� Iva,- spra7P In �ou-P� mw a 1S -err 1)
back i�) -he_s;de,s.
GoaL r,ec&d.s,
Fir
Page 3 of 3 12/28/04

LI/
Facility No is -108 Farm dame
Permit ✓COC
,Pop.Type
Design Current
Date
OIC_ NPDES(Rainbreaker .PLAT Annual Cert }
FB Drops
- - .. _ . Od�O©0�
ff "-_----_
Observed -------
Sl!jdge Survey Date Perm
Soil Test Date;P)14 i Crop Yield a0n 1 in Inspections !�
pH Fields � Wettable Acres 120 min Inspections
Lime Needed IS �� �� o WUP Weather Codes
Cu Rain Gauge Transfer Sheets
Needs P Weekly Freeboard �
ONO- 5940&A04 Rainfall >1
SUFFM M., EO
.!!�. ,
Pull/Field Soil Crop Pan Window
1114 -17T se
11 �kl IL�A SPO
� Z
)10-3
�Y .
Design Widthi
r -----
Actual Width
Soil Test Date;P)14 i Crop Yield a0n 1 in Inspections !�
pH Fields � Wettable Acres 120 min Inspections
Lime Needed IS �� �� o WUP Weather Codes
Cu Rain Gauge Transfer Sheets
Needs P Weekly Freeboard �
ONO- 5940&A04 Rainfall >1
SUFFM M., EO
.!!�. ,
Pull/Field Soil Crop Pan Window
1114 -17T se
11 �kl IL�A SPO
� Z
)10-3
�Y .

Type of Visit 7Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' ! Arrival Time: Departure Time: County:
Farm Name: 4�.fltLA-bt[AS Owner Email:
Owner Name: .irl rti LwQs Phone: _
Mailing Address:
Physical Address: }� ,
Facility Contact: _f___ `__ 12 Title: P IM T t Phone No:
Onsite Representative: Or,' Integrator:
t �!
Certified Operator: �� [ ���� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=4
= Longitude: 0 ° = t =
it
Desi gnC►urrentIII
Design Current
Des►gn Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C*opacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Yes
❑ No
❑ Wean to Feeder
❑ Non -Layer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dai Calf
❑ No
J)DNA
eeder to Finish --I X2
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ No "3NA
❑ NE
❑ Farrow to Feeder
❑ Yes
❑ Non-bairy
❑ NA
❑ NE
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ NA
❑ NE
❑ Gilts
❑ Nan -La ers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co...
Continued
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
E] Yes
�10
❑ NA
El NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
OONA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
J)DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No "3NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility*umber:'gZ- —!O$
Date of Inspection l� /
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 Structure2 Structure 3 Structure 4
Identifier: a3 `'tlI' n9 3SD
Spillway?:
Designed Freeboard (in): 1*
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ YesNo [:]NA ❑ NE
ElYes 9Xo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
h No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? V—Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA EINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes`KK
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Waste Application
lip No
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,.ice
LQNo
[INA [INE
maintenance/improvement?
18. Is there a lack of properly operating waste application equipment?
111111
0 No
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
PNo
❑ 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)
t C -,Y OIL
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes`KK
No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
t(;No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
lip No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
kNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
-7 . c.(� U��( o� re a&i \r t 4o e..s4o-6 Uz) h °\Pass o,*^ 6mye s�-�
Reviewer/inspector Name �-� ! r� I Phone: )O 33 33c7p
Reviewer/inspector Signature: Date: 2 -OD -7
Page 2 of 3 12/28/04 Continued

Facility Number: s2j Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z.No ❑ NA EINE
❑ 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
�ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�LNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;a 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
1P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1P No
❑ NA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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?
❑ YesNo
[INA
EINE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�y _ j J.
i t�5 �
r qa& {,�IiLT �W 4 � , N Tali C�S�J� ,1 Y1 " A� � >? t-ci U
Z
Pt,,-YVIF --S- Ir�Cords
L) S —0�It , ��
N ti c e cs✓r rn. DLCO 4 Qe, C or&s ,
Page 3 of 3 12/28/04

Facilty No. l & Time In 100 Time Out Date
Farm Nam��ee4go `arm -4 Z --Integrator
OwnerSite Rep
Back-up No.
COC ✓ Circle: eneral or NPDES
Desi n Current Design Current
Wean - Feed Farrow — Feed
WearL--M i Farrow — Finish
Gilts I Boars
Farrow — Wean Others
a3S cv �3��
FREEBOARD: Design a4� Observed }
Sludge Survey Calibration!GPlt�1�4 ! IDU
r
Crop Yield Waste Tran0erg—:=J
Rain Gauge r� Rain Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard D ily Rainfall Inspections o
Spray/f=reeboard Drop 0 1 ZO
Weather Codes 124 min Inspections V
Waste Analysis: l 2 -
Date Nitrogen (N)
`J Z •� Z -b
Date Nitrogen (N)
Pull/Field Sail Crop Pan Window
44
.� v

Type of Visit ';�Compilance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit of Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (v ZJ 0(0 Arrival Time: [ U Departure Time: b 17 County._., Region�0
Farm Name: r� [ .[.[�$ POLY Owner Email:
� Q
Owner Name: 7JeA Iu LLl-C(:7L S Phone: _ 11d
Mailing Address:
Physical Address: S0."r•'1
Facility Contact: 41 1/'`,,'kt'!"'Y) Title: rM
Onsite Representative•
Certified Operator: J�k C k t t iVSLY SO �'!
Back-up Operator:
Location of Farm:
g ti t 9 7— (a — �-W_ _L4 ►T� R
Cl' ." '� 1 -ma m %n 14A .
Swine
Wean to Finish
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No: 9 10 & 7�3/
'
Integrator: 1--lem
Operator Certification Number: r g /13
Back-up Certification Number:
Latitude: E10 =11 011 Longitude: 0 0 ❑ / ❑ /1
o� lgZ.4 Lek+w, 19Z(D(K—)=+10ee
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La e.t
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
;NNA
❑ NE
❑ Yes
❑ No
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
*o
[INA
❑ NE
12/28104 Continued

I�Ocility•Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:a3 c23�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes JtNo _ ❑ NA ❑ NE
❑ Yes J' No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes PNo [INA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �fNo [:INA ❑ 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 N ❑ NA ❑ NE
maintenance or improvement?
Waste ADnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
%No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableWindow ❑ Evidence ofWind Drifl El Application Outside ofArea
l"]R. �6�ble (Crop
12. Crop type(s) Qpp, p..f fn 1� V l"11Qi n L � -
SL)X
Ks
13. Soil type(s) W CUgro_m
NJ
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
;V4o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
)4No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
PNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
d No
❑ NA ❑ NE
Reviewerllnspector Name
Of ,W Phone: D H 33 3.3t�,..
Reviewer/Inspector Signature: Date: olp
12/28/04 Continued

FAeility Number: Z— Date of Inspection I 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑kYes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes *o ❑ NA ❑ NE
the appropirate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,kNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P6o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t$IlNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes JKNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes, 13,Vo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 1�kNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes U 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 )ZNo
❑ 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 XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes �dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes kNo
❑ NA
❑ NE
Additio.nAl Comments and/or Drawings: *¢
4-
12/28/04

I
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County. .So��oS9�� Region: E—R U
Farm Name: He,7l x„__Lias Fia�� ± L one/ *A.2 Owner Email:
Owner Name: Neq.r�c _ L_�e.vs _ �1_ / __- Phone: G110• ��3= 9L g
Mailing Address: �2 060 I�Gr�i NG/srG—Glwtr� ��G. %/ce!kl7i! /V� _9
Physical Address:
Facility Contact: �I�•% �a�r.��cfon Title:
Onsite Representative: _ _. I fJJ�i�o .Sknc%�rovl
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
'Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
t, t.ii rs.
Phone No: _Z %G ' ?Y3 /
Integrator:
Operator Certification Number: 0//3
Back-up Certification Number:
Latitude: =' =' 0 Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I ❑
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Puilets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population ;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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. Docs 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 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
12/28/04 Continued

# I 7A4 I.9~ p/aai ala naf- "PA4 foie &cow / !a� •oM,f, P/Cast 06,//r A( ba,,
dm,'le p6svf 0c:n414a3 G /Ge,sy oiC /-Aa c./e,4.f Iaaoa., eAv,
J/tate r./elee,,•+,.o{' �lre Ute$/.yneJ fie.daw✓ /pltasr /Coyer, a1C iy,.S
AbyeYlev,'I/C RCg:p., a l d��'r a oIr He L�,'.,'stin er f 4,a Pe. a,,,v /J^.
Reviewer/Inspector Name a%an� z , '' �fi "IN �Wiy Phone: 9/0 ygG `/Sy/
Reviewer/Inspector Signature: c Date: 3 -g- o s
12/28104 Continued
Facility Number: 9 g
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed .Freeboard (in): a7 .27 g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2�10
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
2 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
ONo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D No
[DNA
❑NE
mai ntenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2 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
Z S� so
12. Crop type(s) iQC//Mud� _ s�fr G
13. Soil type(s) Gf/aB
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
❑ No
❑ NA
D"NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
El►' Yes
No
KM4
❑ NA
© NE
# I 7A4 I.9~ p/aai ala naf- "PA4 foie &cow / !a� •oM,f, P/Cast 06,//r A( ba,,
dm,'le p6svf 0c:n414a3 G /Ge,sy oiC /-Aa c./e,4.f Iaaoa., eAv,
J/tate r./elee,,•+,.o{' �lre Ute$/.yneJ fie.daw✓ /pltasr /Coyer, a1C iy,.S
AbyeYlev,'I/C RCg:p., a l d��'r a oIr He L�,'.,'stin er f 4,a Pe. a,,,v /J^.
Reviewer/Inspector Name a%an� z , '' �fi "IN �Wiy Phone: 9/0 ygG `/Sy/
Reviewer/Inspector Signature: c Date: 3 -g- o s
12/28104 Continued

Facility Number: } Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2"No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ "ElC sts ❑ D� ❑ M� El �
21. Does record keeping need improvement? If es, check the a propriate box l,clow. El Yes ❑ Yes 2 NA [:1 NE
�-�� -> a.1, / "o -ave 7.8, /, (. I 49'44c-
❑ ❑rWedk� El❑ mai El❑ Q
❑ RFiiiFMI— ❑ iflg ❑ G "*ie+d ❑ ❑ am ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Or- •I Ir
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 -No
❑ NA
❑ NE
❑ Yes
2�&o
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes P -No ❑ NA ❑ NE
❑ Yes ['No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes ZNO ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes 2`5o ❑ NA ❑ NE
❑ Yes (EtNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
00
AOvVc2 off;cc
s�Mr/mss
## 01
I'ltaSt fvice mn /� v,., �for• 7t�/ a flow /j.t> e
/ Cast GOHr.i'IVC L1/0,1le �p Oil - iii 4-ZAIr 7e1w4 Gj BtlG,
Cors-
�i6YSs LP 6/1 4V 00`7
4bq�fs '}"b p/'t✓tr�� G/'O,s,� /-�GGJa /►'IlJ�7/b/ ��bSV''y
r/ `
P�taJe
td►t �,'n rK +`rs ,crz,,,ur w�rr/S i i•, S/rru?
ff.'s /� P.t.✓r.,
12/28/04

. A$.I:r i16pi..,
Type of VisitC—ommpliance Inspection O Operation Review Q Lagoon Evaluation
Reason~ for Visit utine p Complaint p Follow up p Emergency Notification O Other 0 Denied Access
Facility Number Date of Visit: o e µ Time:
O Not Operational Q Below Threshold
[Q'�errnitted Eltertified ©/ Conditionally Certified © Registered Date Last Operated or Above Threshold:
41 it
Farm Name: ..........ITS!!" lr Ccs ...........................................................................
County: ........ ��.,,,,,.........................................................
Owner Name: ......................1 nF �c .. Phone Na:............53s.' 3 G g................................,.........
Mailing Address:.............. �°p ....... MCA".... � C �............................... L�f �...L"L� �� X393.......
........ .........................
FacilityContact: ............... `' ..............L!:� ................ Title; ....... ....a!�G!Q.................................... Phone No:...................................................
Onsite Representative: ............. ?.�; . .................. S GcH Q o!1.................... Integrator....... r+ti An IL4 ......................
Certified Operator: .................
.'.+..................... ....... cline,1................................ Operator Certification Netmber:......................,..................
Location of Farm:
[,Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • 6 «
Discharees & Stream Impacts
1: Is any discharge observed from any part of the operation? ❑ Yes ENo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gavinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [►x140
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Mlf�o
Waste Collection 8� TrMnent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yesio
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ................ . ................ ...a............. ... .................... ....... ...... ......................... I......................................................................
Freeboard (inches): IL
12112103 Continued

Facility Number: S __7 Ipg Date of Inspection $ b p
Required Records & DocumenLg
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Farm ❑ Crop Yield Form [:]Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ONO
❑ Yes @No
❑ Yes ❑ No
❑ Yes Q'rNo
❑ Yes [9"No
❑ Yes M No
❑ Yes [!'No
❑ Yes M44o
❑ Yes [KNo
[J Yes ❑ No
❑ Yes 2 No
❑ Yes a<0
❑ Yes ONo
❑ Yes [f qo
❑ Yes E�Ko
Ef No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�-• i� 4 I eN; I i Y ;. t i I I �' ;�rlV i i F (L i f # t$ _.. ,.�: 6 �. 0... F4.
dditiiiiial Comments and/or Drttwin ME a ,
'4M
�:,i?.�.,..ut
�,.J fcco r6, h10 rJo Imo, s sa,,, .
Vi
12112103

Facility Number: & -- a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste inanagement or ❑ Yes RNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes fffio
B. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes [ INC
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2 foo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [�10
1
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ��i, �j) gra.ivt UV-)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA)hMP)? ❑ Yes ER No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
&�o
b) Does the facility need a wettable acre determination?
❑ Yes
B'�4o
c) This facility is pended for a wettable acre determination?
❑ Yes
JRrNo
15.
Does the receiving crop need improvement?
❑ Yes
BN o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
RNo
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
[i"lo
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
,_7,/
L'No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ElrNo
roads, building structure, and/or public property)
24.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
Q No
Air Quality representative immediately.
;tn'ktt{j%j{;i`1;{ts:&��;y;9 . 11!1 vN 8464..,..t4iEia�
Comments (refer to; ueson#)s�;ExplaiaanyYFS answers and/or• any!recoriimendatiansporay�otiter comments{:`.i`'s j,a,';E 3 j3E,i eg;,�'3 i
:S .v�.6�oy{jy}i:'n.{�6�1i
;Userawings;of facihty>tgbetter,explstn sitayat,ons (use additional pages as necessary} [Meld Co ❑Final Notes �'' `
y�l<<rt,R,��.t,,r'��.;��
�--
C�„�
r&5s,!t-. o►� ! h fQ'�
Reviewer/Inspector Name EI,�,`� #� 4 tit „k '�-' <
i ll: EL... _.. wa..!....u.....al � FRM: -% .� *�a �
Reviewer/Inspector Signature: Date: S IrQ b
12112103 Continued