820289_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p[/� Departure Time: �j� ` County:-� Region:990
^
Farm Name:0'44���TT�� Owner Email:
Owner Name: l7 C. e.- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: u /
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone: `
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design.
Swine Capacity
.Current Design Current Design Current
Pop: _ Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Design Current
Ca aci I' Po
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
" '
. D . Ponl
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
�OWerN;.
Turkey Poults
Other
L10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
PNA ❑ NE
NA ❑ NE
�NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facilit- umber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: -1•1C�Its 2- +wQ�S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
[� No ❑ NA ❑ NE
❑ No � NA ❑ NE
Structure 6
❑ Yes j�]No [DNA ONE
❑ Yes T No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlicatiOR
10. Are there any required buffers, setbacks, or compliance alternatives that need
[::]Yes
[ft No
❑ NA
❑ NE
maintenance ar improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
M 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 Croplyindow ❑ Evidence Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Civ �4exl',"&
u
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
09 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA ❑ NE
the appropriate box_
❑ W UP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
[� No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: Date of Ins ection:
T
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �q 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 ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes]
No
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[4 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[] No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[] No
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA [] NE
❑ NA ❑ NE
Phone: 3
Date:
21412015

i ype or v isa: r uompuance inspection v uperation Review V btructure Evaluation V "Irechnical Assistance
Reason for Visit: * Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: 0 7_14WDeparture Time: Fa0 County:
Farm Name: ` 77W'O'l� a �E S 1i'1 Owner Email:
Owner Name: A7. Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: cr
Certified Operator: A1,64,2ZG�e"
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Gapacity Pop.
Wet Poultry
Capacity
Pop.
Cattie
CapacEty Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Dai Heifer
Feeder to Finish
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,ault .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other T
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes] No
NA ❑ NE
NA ❑ NE
071
NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Page I of 3 214120I5 Continued

*acfliq Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fg No ❑ NA ❑ NE
a. If yes, is waste Ievel into the structural freeboard? [:]Yes [:]No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? 0
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? T,
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind J3r�ft ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ
those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
ON E
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P
No NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C}] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No NA ❑ NE
Page 2 of 3 21412015 Continued

acili Number: XL 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 provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
IF
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
If yes, contact a regional Air Quality representative immediately.
r
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
gyp] No
permit? (i.e., discharge, freeboard problems, over -application)
TT
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LI No
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
%47a--12/if
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: q/a­lf 3 3'3��7
Date:
21412015

P*^- Q r7r<�'
f 1
Division of Water Resources
Facility Number r� - ® 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit: • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (,Z3 Arrival Time: 11 _pip,. Departure Time: County:
Farm Name: A cr4uye /M c ar%' ye Owner Email:
Owner Name:LLC _ Phone:
Mailing Address:
Physical Address:
Region: A.I00
Facility Contact: p Title: Phone:
Onsite Representative: Integrator:
Certified Operator: IrL 1, W C011" Certification Number:
Back-up Operator:
Location of Farm:
Swine
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Zq t{ 1 '
Farrow to Wean
fp M
Farrow to Feeder
Farrow to Finish
Gilts
:�F__
Boars
Other
Other
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 15� No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
[—]Yes [:]No [� NA ❑ NE
❑Yes
[:]No
[ANA
❑NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

aciliNumber: _Z.- Date of Inspection: rr /
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 P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (� No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) F
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes M No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
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 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑ Application Outside _of Approved Area
12. Crop Type(s): CDas-1 � Cures 64li�) , �m- , C, n i0p-w
0 _
13. Soil Type(s): [J .a'�V1 � ��g..� j ��j,.v.a �C�„✓
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
M No
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�d No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
D Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes {P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra'nns'`fers ❑ 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 [� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: Zaj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes q) No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes j P No ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
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?
Reviewer/]nspector Name:
Reviewer/inspector Signature:
Page 3 of 3
[:]Yes [P No
❑ Yes 1�1 No
❑ Yes 1P No
❑ Yes No
❑ Yes No
[]Yes M No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 'Fre
Date: 2�
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �' County: .5^Arl "'
c
Farm Name: 1, Owner Email:
- MCLU
Owner Name: A"�' C_t.C' Phone:
Mailing Address:
Physical Address:
Region: );W
Facility Contact: GQ,n,i7 1e-h nfj2�j Title: Phone:
Onsite Representative: Integrator:
Certified Operator: 6aA— Certification Number: 373
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
DesxgnUgCurrenCurrent
Swuie - GapactyPop Wet P,outtry - . Capacty -. Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
x
]Non -Layer
,: . -
Design Current
D ..=Pout ":" : = Ca aci Po .
DairyHeifer
D Cow
Non -Dairy
9.
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Other
Turkeys
Other
_,TurkeyPouets
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
p�
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharses and Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
❑Yes
❑ No
®NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
[� NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
� NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
� No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 2/4/2011 Continued

Fatility Ndmber: 2 - Date of Ins eetion: V
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1�3 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: . S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37 ?-6 W
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes qpNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes �No
❑ NA ❑ NE
❑ Yes 10No ❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Qe /❑ Evidence of Wind Drift 1 ❑ Application Outside of Approved Area
12. Crop Type(s): Coas- t/ .c o(Q Urn 55 rs ) i
m
13, Soil Type(s):of
L C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Cpo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Qa No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 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 No [DNA ❑ NE
❑ Yes No [DNA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [ Yes [WNo ❑ 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 I)$ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Ndmber: 22 Date of inspection: Y1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[VNo
❑ 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
PINo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
C] Yes
® No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
TKckNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�)No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). .-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2,7412011

a.Vpc ui mail; W 4umpllance 1nspec11on v uperauou KevIew l.J ntrucrure r vaulauun `J a Cl'al[ucal RaaaStlailLC
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Tim : Departure Time: OZ.1� �, Cannty"''—� Ste`" Region: KfLQ
t
Farm Name: �e �-T{n�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: u
Certified Operator: W4��� ofile--i
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
I Design Current
,,Design", @urrenrg
. Dgn Current ..
Swiae Capac�ty� Pop
Wet Pouttry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
I
INon-Layer_
I Dairy Calf
Feeder to Finish
7 gelg
jDairy Heifer
Farrow to Wean
Farrow to Feeder
N. ! en
Dr P,oul.
0z)
,6D
I Dry Cow
Non -Dairy
Farrow to Finish
I
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Puults
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 Vj No ❑ NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
[�] NA
❑ NE
[] Yes
❑ No
�D NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facifi Number: Date of Inspection: K
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
P No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
11010
Observed Freeboard (in): 3 Y 4 -10
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
},a No
P
❑ 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
ONo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fWNo
❑ NA
❑ NE
maintenance or improvement?
T
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �g 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 Outsi a of pproved Area
12. Crop Type(s): C., e,4ClI
13. Soil Type(s): �:!� 4 LX :2-
(
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a 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 El Checklists ❑ Design [—]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [F No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[B No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
� No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F4] No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M9 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Rjp 3380
Date:
21412011

e
type of visit: 1p Uompliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: �� County:S' m
Farm Name: iLoau 1, e 1 62 (i y-� _ Owner Email:
Owner Name: TC l L--c Phone:
Mailing Address:
Phvsical Address:
Region: CPO
Facility Contact: 1 An" T ryvo is _ Title: Phone:
Onsite Representative: Integrator:
_r
Certified Operator: n —ruCertification Number:
Back-up Operator: V r[� Certification Number: d�IDO 1 b
Location of Farm:
Latitude: Longitude:
Desargn Current Design Cnr`rent
Design Current
Swine
Capacity Pop: Wef Poultry Capacity Pop.
-
Cattle
Capacity Pop.
Wean to Finish
Layer
I INon-Layer I
Dairy Cow
Wean to Feeder
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to WeanDesign
Current
My Cow
D .. IPoult . Ca aci ` Pb-
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers I
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars Pullets
I
Beef Brood Cow
Turkeys
Other _ �Mori.. Turkey Poults
Other Other
Discharges and Stream lmuacts
L Is any discharge observed from any part of the operation?
❑ Yes
M] No
[3NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
$ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Ep NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
re NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: s
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑NA ❑NE
❑No PNA ❑NE
Structure 6
❑ Yes 799 No ❑ NA 0 NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Jg] 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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FTI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
® No
❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
0 Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
1P No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes TV 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other tissues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes "No ❑NA ❑NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
JkA
N No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recominendationsfar an' me ° e y other comnts.
Use+drawings of facility to better explain situations (use additional, pages as necessary).
4 SJ� JtSld- eo�c�.l�u � 1I
�e,,,ds re J I e,-,j fd 4J 15/11
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/0�33r 33[�
Date:
2/4/2011

rm

Type Of visit: V compliance Inspection V Operation Review V Ntructure tvatuation V I eclimcal Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:. Arrival Time:®,' Departure Time: © : County: SOni
Farm Name: N G j� `�
�an e s Owner Email:
Owner Name: JC 1 , U G Phone:
Mailing Address:
Physical Address:
Region: PV
Facility Contact: of ice- &�% eyw ►mot S Title: Phone:
Onsite Renresentntive: h Integrator: w.,L �i,,
Certified Operator
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: P 71
Certification Number: oa 15�
Longitude:
Design Current Design Current Design
Swine Capacity Pon. Wet,Poalt ran. . Ca aciCattle Ca aci
ry P h. P h'
Current
Po p-
Wean to Finish
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 P No ❑ NA ❑ NE
Yes
❑ No
� NA
❑ NE
❑ Yes
❑ No
� NA
❑ NE
❑ Yes
[:]No
[�iNA
❑ NE
❑ Yes
� Na
©NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

[Facility Number: Date of Inspection:
�l Z
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
c No
°'h NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_ S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _3
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
lcm No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FUM `P° 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 A,
12. Crop Type(s): `
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(g No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fig No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
Qg No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: Date of Inspection: $ �S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tg No
25- Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (A 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)
3 1. 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? ❑ Yes [P No ❑ NA ❑ NE
33- Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes rp No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments,
Use drawinPs of facility to better explain situations (use additional napes as necessarv).
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
C S ��-✓I ell I,
JI.51 _ CV. T�l 11 S z5 IZ.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
R,.4
❑ Yes f d No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [�a No ❑ NA ❑ NE
❑ Yes C�)No ❑ NA ❑ NE
Phone:
Date:
214,12011

10
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: [B;t�x� Departure Time: f'�S r�. County: Q±je spj Region:
Farm Name: s m Owner Email:
Owner Name: _ �J �i LLC Phone:
Mailing Address:
Physical Address:
c
Facility Contact: t�onS Title:
N
Onsite Representative: Certified Operator:
'(�,,
k0
Back-up Operator: ____W"I Qrv1 sL&40"
Phone No:
�/(
Integrator: _/'l �ji^/liA�lU?��1.
Operator Certification Number:
Back-up Certification Number: r
Location of Farm: Latitude: = o =' = « Longitude: = o ET F-1 «
Design Current
Design C�r�ent
Design Current
Swine
CapacityPapulation
Wet Poultry
Capacity Propulation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
52 Farrow to Wean
I
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
.sr —
❑ La ers
r
El Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Ca
Other,'
Rix �._�
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Other I
umber of Structures:
Discharses & 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
[P NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
ERNA
❑ 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
P9NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
151 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
ElNA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

f
1 �
L
Facility Number: —
Date of Inspection 1 - 7-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o [INA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes No MA ElNE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 ure 6
Identifier: /}` 5bLj
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes r
No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes � No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes r No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes t No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes r No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind,Drifi ❑ 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
IP No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
JpNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
tRNo
❑ NA
❑ NE
Comments {refer to question #): - Explain any YIDS answers and/or any recommendations or
any oth,e. rcomments
Use drawings of facilityto better explain situations. use additional pages as necessary): rk
�.
Reviewerllnspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
Date:
12128104 Continued

Facility Number: — Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA ElNE
the appropriate box. ❑ WUP ElChecklists ❑ Design ElMaps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
hNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�t No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�pNo
❑ 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
0No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

type of visit • Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ArrivalTime: %� DepartureTime: QL lT. County: Region:
Farm Name: _ `� —,e TI r fG [�(.Wtl� I S 1�Q^'ful Owner Email:
Owner Name: 3-CT,t—LC Phone:
Mailing Address:
Physical Address: f' /�
Facility Contact: + ` t i` KP k""001 S Title:
k
Onsite Representative: --�
Certified Operator: D"n f c
Back-up Operator: W. 1 k
(LIMn
Location of Farm:
Phone No:
Q,�
Integrator: ��//
Operator Certification umber: �i17
Back-up Certification Number: %oqb
Latitude: =0 =' 1=1 1, Longitude: = o = t 0 «
Design Current Design Current ; _Design Current: ;
Swine Capacity Population Wet Poultry Capacity Population ..Cattle Capacity :Population'
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish L4 LIP
Farrow to Wean 1 Q
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
7
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 No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
-h NA
❑ NE
❑ Yes
❑ No
❑ Yes
TNo
❑ NA
❑ NE
❑ Yes
H�'No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

y.
Facility Number: Date of Inspection I '
Waste Collection & Treatment T
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No JVNA ❑ NE
Struct e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � �
,
GJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
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? Cl Yes
(DNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind D &I ❑ Application Outside of Area
12. Crop type(s) S
�S W f1Wi+yV
SM. lam.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
g] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
49No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Comments refer to question: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better egpiain situations. (use additional pages as necessary):
7 AL
Reviewer/Ins ector Name ` f' p � � � Phone: o—
Reviewer/Inspector Signature: Date: 3
Page 2 of 3 12128/04 Continued

x .. _
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �jNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
nNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1§No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ep No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JgNo
❑ 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
F9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
KM
❑ NA
❑ NE
AddtianalComments and/ar.,`Drawings:
Page 3 of 3 12128104

1 ,,
Date of Visit: " °�°� Time:
Facilin "umber 37rS'
Not O erational 0 Below Threshold
M Permitted PoCertified 13 Conditions]],.- Certified 0 Registered
r�c
Farm Name: tji� .Sown;elf ,f vim 4':n
Owner Name:
Mailing Address:
Facility Contact: 30�- isir; C Title:
Qnsite Representative: ne 6s r4 uOUVI 4 _
Certified -Operator: k at.., Jet
Location of Farm:
Date Last Operated or Above Threshold:
County: —V, , nl
Phone No. CS/�yO 6.771
Phone No:
Integrator: 1,71krTz - Brac�it► �l G
Operator Certification Number: o15-j- 9d
ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 - Longitude .4
Design Current
Swine C'anArity Pennintion
❑ Wean to Feeder
EM Feeder to Finish
ZEE]
51 Farrow to 'wean
j4 v,>
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acitf Po ulation Cattle CalincitV Po UIRtion
❑ Laver I I JE3 Dairy I +— I
❑ Non -Laver I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present La won Area JE1 Spray Field Area
Holding Ponds / Solid Traps EEd L] No Liquid Waste Management Svstem
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
- ❑Yes 94 No
Discharge on=mated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen-ed, 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 zalimin? MP
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any pan of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 50 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Sol,
Freeboard (inches): U
7� Q 7
05103101 - Continued

Facility Number: JV; — 373- Date of Inspection S-2 -43
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [� No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [9 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ,µ
elevation markings? ❑ Yes LJ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. is there evidence of over application? El Excessive Ponding El PAN El Hydraulic Overload El Yes A No
12. Crop type / Peft scfa 1/1 d . 'M•+-- !&CL
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 91 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [�j No
b) Does the facility need a wettable acre determination? ❑ Yes W No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes M No
16, Is there a lack of adequate waste application equipment? ❑ Yes F No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[0 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes [4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes [P No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
. i i - Comments(refer to question #)- Explain gnv YES answers and/or any recommendations.or any a eicomments;
Use draverngs of laciltty ta:better ezplatn sttuataoas. (use addthonal pagesas necessary]r,_- Field Copy ❑ Final Notnsi
Can-ftir.+�t -fo worLja�ao� b�nrks
,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
05103101
Date:
Continued

s
1
Division of Water Quality
Facility Number a a O Division of Soil and Water Conservation
Q Other Agency
Type of Visit `Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit `Routine 0 Complaint 0 Follow up 0 Referral�0 Emergency 0 Other ❑ Denied Access !�
Date of Visit: I U, Arrival Time: Departure Time: r /CJW� County: Region:
FarmName: ' + C `�-�' m Owner Email:
Owner Name: `T u—� Phone:
Mailing Address:
Physical Address:
Facility Contact: I t l Ri S _ Title: VV IY Phone No:
Onsite Representative: 1' r l Integrator: ' + y6
Certified Operator: Operator Certification Number:
Back-up Operator:2ote r �u Back-up Certification Number: `Y
Location of Farm: Latitude: e =' = Longitude: = o
Swine
Wean to Finish
Wean to Feeder
,Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er
❑ Non -La er
Dry Poultry
Non-L
Pullets
Ljiurkey Poults
❑ Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 )No ❑ NA ❑ NE
❑ Yes ❑ No 'PZNA ❑ NE
❑ Yes ❑ No QPNA ❑ NE
❑ Yes ❑ No )SNA ❑ NE
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes &0 ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection b
1 Waste Collection & Treatment ArNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3<9 - S D 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): FL
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes hNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes No ❑ NA El 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 N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [FNo ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PqNo ❑ NA ❑ NE
maintenance/improvement'?
i 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PG No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i 0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
�ACrop
, Window ❑ Evidence of Wind Drift ❑pApplication Outside of Area
12. Crop type(s) Sa 4— r) u-ram 14, O m G ✓ 04-
13. Soil type(s) 6. L-f- 14, fin„ C V
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
12 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
gNo
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
e6No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
tnNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
2No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name S / kc Phone: I
Reviewer/Inspector Signature: Date:
12/28/0 Continuad

h
>E:acility Number amc;n Date of Inspection % g
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )jallo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
61NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
03No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;U NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Pa No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;R)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
10 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
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings,
12128104

{
�.I�i►°ision of Water Quality
-,-VuO cS 3q
Facility Number O Division of Soil and Water Conservation 5'
O Other Agency
Type of Visit Oycompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency ther ❑ Denied Access
Date of Visit: Arrival Time: i / SDeparture Time: ,�� County: Region:
Farm Name: G f Alm Owner Email:
Owner Name: —L C - L C Phone:
Mailing Address:
Phvsical Address:
Facility Contact: &;&Z=,, ,,,t7tt—z Title: Phone No:T
Onsite Representative: �.� __ Integrator:
Certified Operator: /y Operator Certification Number.
'�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o =1 = u Longitude: =1 ° ❑ ` ❑ "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Non-L
Pullets
L,J Turke Poults
❑ Other
Discharges & Stream Im acts
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
E]Dry
Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes X-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PkNo
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — pate of Inspection
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L)
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 property addressed and/or managed
through a waste management or closure plan?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA W NE
❑ Yes ❑ No ❑ NA P 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 CRNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA [$NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA " NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA CRNE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. I•Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs ❑ "Dotal Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift JS Application Outside of Area
12. Crop type(s) &�-Mdo - ! yaeC/Z�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP'?
i
❑ Yes
❑jNo
❑ NA
5Q NE
15. Does the receiving crop and/or land application site need improvement:'
� Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[ZNE
I S. Is there a lack of properly operating waste application equipment?
,R Yes
❑ No
❑ NA
❑ NE
w
Comments (refer to question #): Explain any YES answers and/or any recommendations or..any other, comments-'-"-.
Use drawings of facility to better explain situations luse additidnal-pages as necessary}
z
Th Y �C B� �l�b�S • ��T JGUQ� l�XCc: ✓� .a l Cvc u! _
ReviewerAnspector Name ! 4 Phone:
Reviewer/Inspector Signature: pate: !�
. -S. F •J ✓ lL/L Of

i 1�
.y Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA t9 NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA CR.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
❑ No
❑ NA
® NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
19NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
(9NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
R1 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
UNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
tA NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
® NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
51 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
5 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
KNE
General Permit? (ie/ discharge, freeboard problems, over application)
L&
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
,
IaSNE
33.
Does facility require a follow-up visit by same agency?
El Yes
;UNo
❑ NA
FV '
Additional Comments and/or -Drawings:
r , ,t,� -6e
rt®1gVVi'j µ) -f rr '%rA To G � L i —/" w
Page 3 of 3 12128104

Vj Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation 0 (�i.
Other Agency
Type of Visit 11Compliance inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visitoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
V_- - ( LO
14
Farm Name: Mt I;) Ui_i_t��h� t �!� Cky yl .. _ Owner Email:
Owner Name: �—� c=� Phone: 1
Mailing Address: V `l1t _SQ1 A�_AAW
Physical Address: , 1
Facility Contact: Titlek� hone No:
Onsite Representative:' Integrator: 0
tJ
Certified Operator: W�Operator Certification Number:
Back-up Operator: V% A,Back-up Certification Number:
Location of Farm: Latitude: o Longitude:
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
ETF.eeder to Finish
9L4-t
0�
tE�Farrow to Wean
C:)
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharees & Stream Impacts
Dry Poultry
Lm
Non
Turke
Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EE
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Covd
Humber of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
IrNA
❑ 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
;bNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�INo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�TO
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Nursrber. —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes N. No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes ❑ No VNA ❑ NE
Struct e 9 tructure 2ff Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 7 - V lC sm 3_
Spillway?:� 3n
Designed Freeboard (in):
Observed Freeboard (in): Z _
5. Are there any immediate threats to the integrity of any of the structures observed?
��,,��,,,
❑ Yes Lio [I NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
��
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes (Uio ❑ 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 N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J!�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
44No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
IReviewer/Inspector Name Phone:kA 10 y _"� j ,3 XAIJI
Reviewer/Inspector Signature: Dater ) U?'*
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes} No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ipNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ 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
Wo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
�No
El NA
El NE
12128104

Facility Na. Time In Time Out Date
Farm Name t`e.. Integrator
Owner / C' S Site Rep
V+- Operator =JQ Qy- 4/A l&ks No. _
Back-up No. t 1
COC ✓ Cirde: eneral or qiEES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean -- Finish
Farrow — Finish
Feed, Finish
Gilts / Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey L�
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
PEAT
Daily Rainfall L/
120 min Inspections
Date Nitrogen (N)
do, l f .
-5)2-L 3,Z.
i ZL( O,7S 1._.
Observed
Caliibration!GPM
Waste Transfers
Rain Breaker •�
Wettable Acres
1-in Inspections %.�
Date Nitrogen (N)
Pull/Field oil Crop Pan Window
�n
ice-+ 5
'c� G Z
11J }
Z..

Facility No. Time 1n— Time Out Date
Farm Name 1 0l cm 11 i P _ Integrator (V) 'f
Owner Site Rep
Operator No.
Back-up No.
COC Circle: General or NPDES
Design
Current
Desi n
Current
n -Feed
Farrow -- Feed
can - Finish
Farrow - Finish
ed, Finish
Gilts 1 Boars
Fa ow -Wean
Others
FREEBOARD: Design _
Sludge Survey
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop _
Weather Codes
Waste Analysis:
Date
PLAT
Daily Rainfall
120 min Inspections
Nitrogen (N)
Observed
CalibrationlrPM
Waste Transfers
Rain Breaker
Wettable Acres
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil crop Pan Window
i

type of visit lr'Compliance Inspection O Operation Review O Structure Evaluation Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Q Departure Time: ; ( County: Regio-
Farm Name: ' r M C - r ' r-�L•- l� ,✓�-f Owner Email:
Owner Name: L Phone:
Mailing Address:
Physical Address:
Facility Contact: . Title: Phone No:
Onsite Representative: // Integrator:i'A�
Certified Operator: _ !'L92&2 / ,! Operator Certification Number: , s��0
Back-up Operator: go C V411 G� +- Back-up Certification Number: A C'
Location of Farm: Latitude: ❑ ❑ Longitude: ❑ ° ❑1 ❑ u
Design Current Design°.„.: Current Design Current
Swine a Cap*aty .Population Wet Poultry Capacity01
Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder ❑Non -La er ❑ Dairy Calf
Feeder to Finish qDairy l leifer
❑ Farrow to Wean DryPou'1 ❑ D Cow
ltry,
Farrow to Feeder r7 Q Dv '� `"� W ' - ❑ Non -Dairy_
El Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ GiIts ❑ Non -Layers
El Pullets El Beef Feeder
❑ Boars ❑ Beef Brood Cowl
❑ Turkeys
❑ Turkey Poults 1
❑ Other
❑ Other Numtier•,ofaStructures-
Discharees & 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
allo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
NNo
❑ 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
C[No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
QQ No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: A2- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 29 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes (,No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
RNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
C,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
[54 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
0No
❑ 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
U-No
❑ NA ❑ NE
maintenance or improvement?
Waste ARPlication
10_ Are there any required buffers, setbacks, or compliance alternatives that need El Yes
9 No
❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
lNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) / zcn 1 ±rZ / Ze I -
-
—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5Q No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
Q0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YESj.�nswers and/or any recommendations or any other comments.
Use:drawings,'Ufacility to better explain situations use additional pages as necessary)
Reviewer/Inspector Name f - ��/ - -►/wLL _ -- - Phone:
Reviewer/Inspector Signature: Date:
rage 14 of J [L/Zo/vs a onrururu

Facility Number: Date of Inspection �o
• Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W-No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
UZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9,No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JVNo
❑ 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
MNo
❑ 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
ZNo
❑ 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
A No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[51,No
❑ NA
❑ NE
Additional Comments and/or Drawings: At.,
Page 3 of 3 12128104

e
Type of Visit 4e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t/L�J Arrival Time: /O{'� Departure Time: '� County: Region: - rn =•
Farm Name: Rea lei_!` ht��a-st� f r� 1 5a �' Owner Email:
Owner Name: `f' -- _ Phone: --
Mailing Address: �15' I7 , 3OX .��� l S',-- Z/ if
Physical Address:
Facility Contact: I`CQ�y/�� ��1 Title:
Onsite Representative: ,e,� _
Certified Operator: t tiw�
Back-up Operator:
Location of Form:
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: S 'ynaa
Integrator:
Operator Certification Number: / 6 :�y6z
Back-up Certification Number:
Latitude: = O 0 d ❑ Longitude: ❑ Q ❑ I ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers__
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Cattle
Design current".
Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: ®'
b. Did the discharge reach waters of the State'? (If yes.. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
e
❑ Yes NjNo ❑ NA ❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
XNo
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 5-
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
M No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: i2faaui re- w ­y `
Spillway?:
Designed Freeboard (in): Z g :•p�o2
Observed Freeboard (in): —�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ESNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
C&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
(gNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[Z 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
KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[0 No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ElApplication Outside
of Area
12. Crop type(s) #et4" / Sntd t1� �/'ac; I'--
13. Soil type(s)X L� f Am2e/ C_ -t-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
91No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[:]
Yes
[KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Reviewer/Inspector Name �,r� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection 3 r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ [No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C.No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
SNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
K No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
N No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
54 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®.No
❑ NA
❑ NE
Addiiional Comments and/oir Drawiags:
12128104

Site Requires Immediate Attention:
Facility No. R Z- 7-4 cj
DIVISION OF ENVIRONMENTAL MANAGFMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: u .1995
Time:
Mailing Address: D t
A
Integrator: XALVA4F' fi11f'n r Phone:.
On Site Representative: u Phone: cQu - S
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: Z441
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon ufficient freeboard of 1 Foot 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Y r No Actual Fre�eboard:�Ft. _Qlnches
Was any seepage observed from the agoon(s)"' es or No Was any erosion ed. Yes o 10
Is adequate land available or ? es or No Is the cover crop adequate? Yes r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelli Yes, r No
100 Feet from Wells? es No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue e: Yes or io
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(No If Yes, Please Explain.
Does the facility maintain adequate waste management . (volumes of manure, land applied,
spray irrigated on specific4creage�ith cove F crop)? Yes r No 1
Additional Comments: \ &N
1
Inspector Name
cc: Facility Assessment Unit Use Attachments if