820294_INSPECTIONS_20171231

�V
NUH I H LAHULINA
Department of Environmental Qual

Division of Water Resources)
Facility Number L - Division of Soil and Water Conservation
Q Other Agency
r
e of Visit: ompliance Inspection Operation Review Structure Evaluation Technical Assistance
son for Visit: CrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: p County: ,��_— Region:
Farm Name: Sf::�zr rt.-
Owner Name: n
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Ste_ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Carrent
Capacity Pop.
Design Cui rent
1101
Wet Poultry Capacity Pop. Cattle
Design Current
Capacity Pop.
Wean to Finish
9
-
;:.
Layer
Wean to Feeder
Non -La er
—DairyCow
DairyCalf
Feeder to Finish
Design Current
D . Poai Ca aci ;iP,o .'
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turke Poults
TurkeysIE
Other
:
E3i
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[21 No
❑ NA
0 NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
0 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
0 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
RLNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - A5= I Date of Ins ection: --1— 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [c No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes EZ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Desilmed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z 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 I[ 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 Ed 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 allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of/Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EgLNo ❑ 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
[ANo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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 [2�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 [allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - I Date of lus ectioo: — J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O—No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes JK No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [RNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes RNo ❑ 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 RNo ❑ 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 DNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[�d_No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNW?
❑ Yes
12INo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
[3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
MNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: ZZ —/ �2/7
21412015

f
ivi'sian of Water Resources
Facility Number r.� - �� � Division of Sail and Water Conservation
©Other Agecy
Type of Visit: gDOCompliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ,;L—/Ip Arrival Time: p Departure Time: '. 3D County: Region: j�ta
Farm Name: S n (:�- S�}--.� I cam! H'� Owner Email:
Owner Name: 5/1 &=;z Phone:
Mailing Address:
Physical Address:
Facility Contact: 115A y n9 �,r-y Title: ©ww Y/`
Onsite Representative: integrator
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
�
.�
Design Currents= '-�6*Degn
Current Design Current
Swine
Capacity Pop. Wet P ultry 'Capaity
_Pop +C•attle Capacity Pop.
-_
I
_
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non La er
_; Daia Calf
ceder to Finish
Dairy Heifer
Farrow to Wean
"Design Current D Cow
Farrow to Feeder
DrPoultr Cd sett
Non-Dai ry
h
Farrow to Finish
PLa ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
�
�- Beef Brood Cow
m
:. z3i
Turkeys
Other _-
Turkey Poults
'
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes L?J-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes.. notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any pan of the operation? ❑ Yes El 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 2/412015 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
f 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes EgNo
❑ 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): T7 T
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed`?
❑ Yes [RNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes � No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes _[E�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ®,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes p No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes ff�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)�/rn-aat�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z[ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes JRNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes [a No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? ]fyes, check 'KYes jeo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design 0Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. �esNo ❑ 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 Ajq No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes la -No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q�;_No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes g 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 Lallo
❑ 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 ZLNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes RNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [I -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: v`c• Phone: 10
a
Reviewer/Inspector Signature: _ Date:
Page 3 of 3 21412015

I
Type of Visit: r�Zutjne
nce Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit: r / $' Arrival Time: Departure Time: / ; p Couaty:8' Regioa:z)
Farm Name: _ G Owner Email:
Owner Name: G4h. Phone:
Mailing Address:
Physical Address:
Facility Contact: /j�CZ�- isZA
:2 'tic: Phone:
Onsite Representative: Integrator: A;
Certified Operator: jam, Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Gnrrent
Swine Capacity Pop.
Wet Poultry Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
I INoD-Layer I
Calf
Feeder to Finish;
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , Poul Ca aci
Po .
Non -Dairy
Farrow to Finish
La era
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turke s
Other urkey Poults
Other I 10ther
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)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes _Q No
❑ Yes ®..No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of inspection:
A Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5�[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
(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
nNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[S 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
fj�'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence
of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Y/l�?I,��cr _1 U z�/ 52' Ij
13. Soil Type(s): "z_ kx) z , y4
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? 0-yes to ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [E�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 ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
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
EgNo
❑ 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 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes T(�54-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 C�J_No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes 0No [:]NA ❑ NE
❑ Yes Jallo
❑ Yes 0 No
❑ Yes rff-No
❑ NA ❑ NE
❑ NA ❑ NE
❑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 fuse additional paces as necessarv).
,. /-c � � [ fl �"�u-� Via` �'✓'� �r�-�-,- s�r�y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

I
t
(Type of Visit: QD'Compl.iance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
C�'R I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergenev O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ; p O County: Region:
Farm Name: 4n,'L 5n;eCttt"t— d- jt} pr1 5/G' Owner Email:
Owner Name: AR a. I G: f 'q '7 r- HC� Phone:
It
Mailing Address:
Physical Address:
Facility Contact: 17�W C /�,�vyC Title: 4�,7 rr Phone:
Onsite Representative: Integrator: rj 15
Certified Operator: [ Sr��� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desig .. aD
n Current
tom; Current
..,.
Design Current
Swine
6.8 act
ity Pop.
Cattle. Gapacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
afl
Non -La er
Design Current
Dairy Calf
Dairy Heifer
Dry Cow
Feeder to Finish
Farrow to Wean-
Farrow to FeederD
,Foul __= Ca acrty 1?0
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
.'
v-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: I Date of Ins ection: 1
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [X 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 ® 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 [allo ❑ 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 2 No ❑ NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CS 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 ['6No ❑ NA ❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop 7 ype(s)://l1i ��� /(�yta!� _-y�/ CD rI'L
13. Soil Type(s): - -s o= 1 11 - TT
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 �10 ❑ 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes J�q No ❑ NA ❑ NE
0 Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [4No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3 No
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [S-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [IgNo
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 J&No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA [] NE
❑ Yes [&No ❑ NA ❑ NE
0 Yes jM No ❑ NA ❑ NE
❑ Yes P§ No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
Yes U No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
Comments (refer to question f : Explain any YES answers and/or any additional recommendations or any other comments. 1
Use drawings of facility to better explain situations fuse additional cages as necessarv). 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:�C
21412011

_Jvs bIHS 11I011aOG
r Division of Water Quality
Facility Number Qa• - a4 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: t& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: S
Departure Time: i is
County:
Farm Name:
u
Owner Email:
Owner Name: vto
fimPV ('UW_
Phone:
Mailing Address:
Physical Address: bt//A ,-_U ,P" {(0
Region: ER0
Facility Contact: _fln yCu- Title: 01y'y^ Phone:
Onsite Representative:aL� �5� ,Sji��y Integrator: M-13
J
Certified Operator:Q� 1C�1�CU Certification Number: 17.a".,
Back-up Operator: AD `PIlr u 1) DI MS Certification Number: y�
Location of Farm:
Latitude:
Longitude:
DesiDesign Current
Design Current
Swine Capacity Pop" ,Wet"Poultry Capacity Pop..
Cattle
Capacity Pap.
..,�.
Wean to Finish Layer
airy Cow
Wean to Feeder
on -Layer
airy Calf
Feeder to Finishairy
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul Ca aei
P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other =t7t
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
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 3 21412011 Continued

acili Number: -I Date of Ins ection:
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1^
Observed Freeboard (in): �n
5. Are there any immediate threats totheintegrity 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
C@ 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
CoNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C' No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
U Yes
U No
U NA
U 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
ta 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
1�0 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
5d 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
El Waste Application Weekly Freeboard ❑ Waste Analysis 0 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
n No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [-]No RNA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - - I Date of Inspection -
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 5a 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 {RNo ❑ 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
2 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
'f�j 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
fR 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
CR No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #i): 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).
�Owne- 1s haA same mt4sble, . Som-e records Ne'e. Jolt r4 h 1'1.f_ bP_ war �A h of fta f ,
reeboc�dy. Iz Ie v ha0�r j r lssi� Plea e oil- w he, _eb Fay„ i mt��r
have. We 'h anfa�M aid- a w ! Ra a s we e
colmckdvl ns ec'�i" �4N1 Yvf e nod' 19v Ash s VC d w
1 09 y
on rec
a , Ca) l b40 sckdV WL ihr ,�, ntx-f O� ,
as slid svrYe "a, -fir��,� 013, , P1eajeyLy- 01,_ next- yeq.
� f dal -of ao��]
p Q[�cU OL`hil�t�(1►1 wr) ins Pc'hOn, MaiW h !1
p
Cvdrh`oa1 ��esd�,l�6�a� �vc,A-cgpyJ.
Reviewer/Inspector Name: a(h S�hh?14- Phone:q f 0- 4,12�
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

� } Facility No.33�-aqq�Farm Name CU Date 163 3
Permit _� COC OIC NPDES (Rainb-reaker PLAT Annual Cert Daily Pipe)
ul
its uro s
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
�� ':Tsil�l:Tr9TTTe1
Calibration D. --RirigSize
(in)
r - gpm)
Actual Flow
Design r _�--
Soil Test Test Date
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres _ ✓
RAIN GAUGE
Lime Needed 41f
WUP
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu-1 ✓ Zn-1 v
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
o i iawrv= mm
..
..
��
►L
r
'
F1 _
ll
�.
I�
�
►a
, it �
• J
Verify PHONE NUM$ E�RS and affiliations
Date last WUP FRO if 4'614{v FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump04
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 lb/ac
id*y Trdw/

- .. -t._! f%
Type of Visit: 19FCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (5)-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: $ �. Departure Time: County; So Region: FXo
Farm Name: f�ohPy� t,{i 4yrr,�7— Owner Email:
Owner Name:! Phone:
Mailing Address:
Physical Address: a d Dumi
Facility Contact: 441 fl t' GW& Title: awn � Phone:
On site Representative: Oal f levcU t- Integrator: H~ Q
Certified Operator: Ha I (x+ Certification Number: jq,39
Back-up Operator
Location of Farm:
Latitude:
Certification Number: 117"1
Longitude:
Design
Swine ,;- Capacity
Wean to Finish
Current Design LGIrrent
Pop. Wet Poultry. Capacity Pop.
Design Current
Cattle Capacity Pop.
i La er
DairyCow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Design Current
Dr, Ponl_t . Ca aei 1;0
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPullets
Beef Brood Cow
{
Uther
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[Z No
❑ NA
❑ NE
0 Yes
❑ No
[DNA
❑ NE
❑Yes
❑No
[DNA
❑NE
[:]Yes ❑ No
[:]Yes ' 4 No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

acility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
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
0 Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®No
[:]NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Vg 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 WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > f 0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
U Yes
� No
U NA
U Nh
❑ Yes
J�j'No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
0 NE
❑ Yes ni
No ❑ NA ❑ NE
❑ Yes Pj� No ❑ NA ❑ NE
❑ Yes IR No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes to No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? D Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[�iTNA ❑ NE
Page 2 of 3 21412011 Continued

Facie ' Number: OM - Qq Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M7No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes R[ No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Cj NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document ❑ Yes 1,;J'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Callo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C'No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MR No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
r'No
❑ NA
❑ NE
__.
�r 6Xd- ` 06116'
5, Pefh li-)dw , ,h ahoi�uzh O�y C�af a1.
y. orto-4 1-Reds W$f_ P1,91 w7 ` i6baao bt%f grole�
6cal
Reviewer/Inspector Name: �� �Scbul'lq-'
Reviewer/Inspector Signature:
Page 3 of 3
3� a
Phoney
Date:
2/4/2011

1
Facility No. Farm Name T �iG� Date
Permit COC / OIC_ NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
FB Drops
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
-
+
l`'i 'Ti►7?t1-' WSTiMSIM
Design •
�r!��-------
rT
Soil Test ate
� � �� ��
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres 6,
RAIN GAUGE
Lime Needed
WUP L---�
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu-I ✓ Zn-I ✓
1 in Inspections
Check Lists
Needs S (S-1<25) 0
120 min Insp.
Storm Water
Needs P
Weather Codes
Waste Date
i
- 60 Da
+ 60 Da
N Ib/1000 Gal
,
off
..
�.
I
+ u.
M�
NUMBERS and affiliation
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

d.dga(g
Yj Aq)irm4 n1 �4
-+�'1� Irti

t ype of visit: �cx r.ompuance inspection V vperauon Keview t..i ntrucrure Evatuarion V i ecnmcaj Assistance
Reason for Visit: (BrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: S
Farm Name: q- �0111pi I CUOwner Email:
Owner Name: gal RQ(I,eyr-A Phone:
Mailing Address:
Physical Address:
Facility Contact:
`�]jS)o' Inu" � ��'-- . Rol-ehory
I �(l T�(,I e" GU Title:
1
Phone:
Region: F)Q6
Onsite Representative: V I Integrator:
Certified Operator: a t-t Certification Number: Ig3ag
Back-up Operator: Ge4 ii Certification Number: jggq'
Location of Farm:
Latitude:
Longitude:
"M sm IV " r W� 1: ' .. :!1' . k 44F "GME•i k11.I��-Y'
R' Design Current Design 'Current Design Curren#
t acity Pap. Wet Poultry Capacity Pop. C*at[le Capacity Pop.
Swine
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
.....:., .: °:: � - - �
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Dry P, Altr ' . Ca sci P,o ,
Layers
Non-Dai
Farrow to Finish
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turkevs
Beef Brood Cow
K°" " •
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c- What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes &] No ❑ NA ❑ NE
❑ Yes ❑ No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

1:acili Number: qa -a Date of Inspection: $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
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
[RNo
❑ 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
2 No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O 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?
. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops ditlkr trom those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination'?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
U Yes.
No
;ZS Yes
�-No
❑ Yes
10 No
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
the appropriate box.
❑ Yes LgNo
❑ Yes 5 -No
❑ Yes No
❑ Yes No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes t'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 RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
U NA
U NE
❑NA
❑NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
D Sludge Survey
❑ NA ❑ NE
NA ❑ NE
21412011 Continued

Tacili Number: - Q Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ji-g] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Wo [DNA ❑ NE
the appropriate box(es) below. TT''
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No J;] NA ❑ NE
Otherlssues
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 WNo ❑NA ❑NE
❑ Yes J�JNo ❑ NA ❑ NE
❑ Yes `�No ❑ NA ❑ NE
❑ Yes �a No ❑ NA ❑ NE
❑ Yes t;� No
❑ Yes J' No
❑ Yes to No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES ansW.ers and/or an):.additional}recommendations or any other, comments.
Use drawings of facility to better explain-situations,(use`addtttanal_pages=as necess$ry)�
�� Lq)oi,Sod- S`fAi�7r eer YV Or d� n C 0 ✓�
5't
�'li116- 4Ap b� sfpd- down �Dr ftftV1 6z,d Itii11 �p rerldi
N Of q�I� � .�+p� +0 rye
r�9 l� a d V,
�
[iR[ds have b-PP,, yo) d- d op, al t y,ear d v-e * aJ c� yvea-N� -
D" la �r iv � - i � ��� da F
eamr IDq e r i
���,�✓d�-�'��ls cr-e r� 00d_r4.a p. Well �o��rr�a� �� 9oa� WCA'd-sl
� p
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
F}" Phone
910.43 U 3 ( 61�
Date: b i
1141 011

0
Facility No.50 Farm Name
Permit COC
(ROO
INI'f'1c(AqArt,-PrC'-ft Date
OIC� NPDES (Rainbreaker PLAT Annual Cert }
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
,L)S Uni 1 an/v
_ .... _ -Design
Flow
Actual Flow
Design Width
Soil Test Date LS i f
pH Fields l't-11,AA�
Lime Needed
Lime Applied
Cu-I Zn-I v
Needs P 11
Crop Yield %fTVE5n� ,/, OR. d 0 !a�
Wettable Acres
WUP 11-11
Weekly Freeboard4RDiYr�t�
1 in Inspections
120 min Insp.
Weather Codes
Transfer Sheipts
RAIN GAUGE I--,'
Dead box or incinerator
Mortality Records,L
MIN TEM
I � j
,
!
L•r ', IM
i
iiM] 0lt
! i
y3 — / -- ---
Verify PHONE NUMB RS and affiliations
Date last WUP FRO j a$1(0 , Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac
U�-v (� (a1vt df5yn 106lj I(ve a It
U "
App. Hardware0��d,�l$

J. -
� IRS �3vj I iI a1 IQ
Type of Visit (SCompliance 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 aQ Arrival Time:Departure Time: �n County: S1?Q S Region:
Farm Name: '' II 'Q t�A (,I)* Owner Email:
Owner Name: TQ� 6. 'Q Cu Phone:
Mailing Address:
Physical Address:
Facility Contact: s2l 4mfv C Title: 0�'mr Phone No:
Onsite Representative:: Integrator:
Certified Operator: Operator Certification Number: �aR
Back-up Operator: C6, hre Back-up Certification Number: �g
Location of Farm: Latitude: e = I Longitude: = o = 6
Design Current
Design Current
Design
Curren#
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apacity
Population
❑ an to Finish
10 Layer
❑ Dairy Cow
❑ an to Feeder
10 Non -Layer
I
❑ Dairy Calf
® Feeder to Finish
`1 Lk 000
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Pouits
❑ Other
Plumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes QNo ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1�[ No
❑ NA
❑ NE
❑ Yes
'PrNo
❑ NA
❑ NE
12128104 Continued

F"
_. FacilEity Number: Sx — aQ Date of Inspection 1 Of
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ 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): p�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
�j No
❑ NA ❑ NE." _
(ic/ large trees, severe erosion, seepage, etc.)
x
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
U 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? 1,;2 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
PNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[XNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
tR No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
J�jNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or l 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) Ay;tA&j j j.p L$ ' X fi'I'V S
`Small arnfl) 0*38cd,e K44AAnkaj
I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1,2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IR 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
�j No
❑ NA
❑ NE
$S
Reviewer/] nspector Name ,�'�S'b ';;7� Phone(`''
�lu
�rfDJ33— �j 3DiDjG3j
Reviewer/Inspector Signature:
� ,�_ Date: au I, ao to
Page 2 of 3
I
Continued

Facility Number: %a — aQ Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box_
❑ W1JP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. VrYes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking JR Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33- Does facility require a follow-up visit by same agency?
❑ Yes
1,2 No
❑ NA
❑ NE
❑ Yes
❑ No
NNA
❑ NE
❑ Yes
tR No
❑ NA
❑ NE
❑ Yes
❑ No
[3NA
'kNE
❑ Yes
151-No
❑ NA
❑ NE
❑ Yes
❑ No
JR NA
❑ NE
❑ Yes TR No ❑ NA ❑ NE
❑ Yes 15rNo ❑ NA ❑ NE
❑ Yes T'No
❑ Yes IRNo
❑ Yes J�jNo
❑ Yes qNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[-I NA ❑NE
w I.D ���� area.. G�o>re- down
-7, Piegee nvtl('� Q, b�� s�C�- &� l ajco coed " s✓n, m
IxTSO&s ,,� Sri ` !; �d �- ! r`i�t-PoL b Ah'a 1� r
l
fta -Relks -t-h !s Sef!� 1 `��d cre_ .
al ��ge u3e Cali k ',�Jow rab of 13o it1hr jb ci c� Qc�al �� •� � 4�°'`,
�! {p'ea P- rod
o" V� �r`u acry TVr w Slays (jRR�
+lo a[ �115, le6e�eorfe& sIfffel Je��mgl.j
Wo edideAW
.Z? S1V* 7 r
� CIGY CQ�b'1 Ctb,,,e, Aok
Page 3 of 3 12128104

O�S
Facility Na_ ��`a4`( Farm Name �� * lV�" Date !V �� Q
Permit ✓ COC OIC� NPDES (Rainbreaker PLAT Annual Cert }
Pop.
Type
Design
Current
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
aS F v4 U -h t ahiV I
OEM
Design Flow
. •
-------
Design Width
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed _� Weekly Freeboard Mortality Records t/
Lime Applied ��S(�'j 1 in Inspections
Cu-I c/Zn-I ✓ 120 min Insp.
Needs P Weather Codes
Cron Yield Transfer Sheets klr
Waste Analysis Date
b
1 '
C of a 1-5 *& h HYJI O+ 30, y1rk0,Ff
Verify PHONE NUMBERS and affiliations
Date last WUP FRO II (1$IO , Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
Pf"j &- r ton C� -f4- !
App. Hardwares J
14
1 Ll IT ob W
- 1 la $rrg� j 3X

Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: r
Farm Name: 4&l G `Q_ Owner EmaH:
Owner Name: f7U'1'Ps,ICU Phone:
Mailing Address:
Physical Address:
Facility Contact: FTU MAtIvEcIr Title: (U lvt9t1` Phone No:
Onsite Representative:i6( 0 Integrator: I Y h
Certified Operator: Ral flOA4)V - Operator Certification Number: >Ay4 PIMS'
Back-up Operator: Gef��Q f5ve Back-up Certification Number: 1'72y
Location of Farm: Latitude: 0 ° Longitude: °
Design Current
DesignZurrent
Design Current
Swine Capaty Population Wet Poultry
Capacity
Population Cattle CaPo pacity pulation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
airy Calf
Feeder to Finish L4 49
Dairy Heifer
❑ Farrow to Wean ay Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑Non -La ers
❑ Pullets
❑ Boars ❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other ❑Turke Pouets
❑ Other ❑ Other
Number of Structures:
Discharizes & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
IR 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RtNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:0 a, — a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 12 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): q
Observed Freeboard (in): CZ3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes WNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [ iNo ❑ 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
N No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo ❑ NA
❑ NE
maintenance/improvement?
t 1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CRNo ❑ 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
t
0n t�vq
12. Crop type(s) �`�)(�
t7frnt �
—{o-f-Area
,
4410, poJ�-_e � Jt�Q� (J!O/� `%f ' �f lit
;
+ ^M*te�
(a/1 �t�i� �'
13. Soil type(s) �. 90— 5 ; WOL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5J'No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IR' 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
RNo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES:ansvrers and/or anyrecommendations or any=¢othercomments
o . in -
Use :drawings, of facility to better explain situations. (nse addtfional gages as necessary):
Uo
Reviewer/Inspector Name E ° I Phone: [0 L133—,1W
Reviewer/Inspector Signature: %4)., „Q,,AftZZ&_ Date: NW n_a002
I
Continued

Facility Number: —aq 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 fgNo ❑ NA ❑ NE
the appropriate box. ❑ W"Up ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E-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 t)_jNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No U NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J'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 s 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
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tallo
❑ 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
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
WNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
14.Oea-aAo, hex e e, eaco-eJ 'Ovr r ray► ) sri"a I�ave_aja"?_
I a� S11,* c lea,owi' M aoo8►
40we-er -%I ylr ,rfer , and- n end r art ese 0W#jkelai. ��e -'eidr have *eve- � s' �a d- aiL*l 11"I et 4v b-e USA/,
�i
I3�, Lime wa r a pea aam pe- lay-f Xoi/ 46.E ,
. �`~ ©o©-oh � s o),h rye c�,&s U) l a j oo-1 wh k b" yat r ! Plat J �
"Jeedt K )L-N VV a/ 1 yve , -er 9 ra-u� j n s' 1?r►'11 q ,
A V �l
C, ood -pw, , a re(ark . Gor-d ..s-No-�ry,e .
` ball e!1! ble-slid s,�„P *,r�., , Mai
gg^ 9 N ,e ,`�-, o f oa ,ns
re
PV C Q Yv zo ( r�r D1P
A�� V n �;
rnq 0 of f 0-� cap�tT� g( re tl�ec�r( ur��cr�
Am I F�eMl p�,�i
Afh', Nitf S'o54-oma- Qrl.�fin_ 0MPrnn� �i �-�S-Sil�f�J$� Ho IUAI%J
zu:;- a3. a-)o ,q k3 5'C«0 � 3�f. sb ,f- 12/2&04
k4iePgh 1Vtr a76gq- 10C OrLib0 �680$'9011�s lam ifs

`Facility No.�K I-Z? 9 4Farm Name
k11C&flWDate
h(o
Permit ---`COC
OIC
NPDES (Rainbreaker PLAT Annual Cert )
Pop.
Type
Design
Current
a'i�f S
FB
opsel
s
On
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
.�
Ratio Sludge to Treatment Volume
Design Width
Actual Width_
-------
a �{O
Soil Test Date Wettable Acres
pH Fields WUP
Lime Needed Weekly Freeboard
Lime Applied A' rI h 1 in Inspections
Cu-I Zn-I �t�►� 120 min Insp.
Needs P 9A0 1 7",Q Weather Codes
RAIN GAUGE
Dead box or incinerator
Mortality Records
Crop Yield B@'v!1dU
— Hf
d Transfer Sheets n
Waste Analysis Date
f Q
0
- 60 Da
+ 60 Da
N Amt Ib/1000 Gal
,
H
,
Pull/Field..
..
i
_,f.1
1
M 10- [ r -i -Of r C4'A 4 e ri-.rfrA-v-? a y
Verify PHONE MUMBERS and affiliations
Date last WUP FROI1106 Rec 31aq((t Date last WUP at farm
FRO or Farm Records "'1
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
1
App. Hardware
ACjIf,op,gC=3y.5*
z
- (Os000
�q Sap 6$ 0-7,53 jQ
3-0
�a O 16J 0000
3I

n ims L7Vj 1 r hgIns-
I
Sk Division of Water Quality
Facility Number $a aQ 0 Division of Sail and Water Conservation
0 Other Agency
Type of Visit ?a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: lL3J�l5ra Arrival Time: Departure Time: l rQQ H County: M Region: M9
Farm Name: flQUff !! Owner Email:
Owner Name: 6. iY1�Vl'y[t Phone:
f
Mailing Address: O BO IC bq� SU{r-� 61h.VA S
Physical Address:
a I �
Facility Contact: i6e C Title: Owne- _ _ Phone No: 3 -a1 I I q `V
Onsite Representative: v Integrator: NINPh, F,1
Certified Operator: �n. .GV* Operator Certification Number: fly✓ 14 $
Back-up Operator: � O 7. L� Back-up Certification Number: AWA MY]
Location of Farm: Latitude: ❑ o Longitude: ❑ ° E
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Gilts
Boars
Other
Lj Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Daia 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?
❑ Yes [ RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 5? No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

4 I Fachity Number: I : 41 I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ERNNo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): IQ
Observed Freeboard (in): as
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes I`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 RNo ❑ 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? 19Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
C'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
CWNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
WNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift [:]Application Outside of Area
12. Crop types J50M,i iL (Bj-11a 0T
13. Soil type(s) OQ1 S1'.W&B s,, XV Is-
AbAr L
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? C'Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
W 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
Wo
❑ NA ❑ NE
Comments (refer to comedothr ommentsn aaaontynYoe.
13se drawings of facility to better explain sitnations. (use additional pages as necessary):
Phone:
Reviewer/Inspector Name 310 g3�3-�3� �3
Reviewer/]nspector Signature: Date:
Page 2 of 3 v 12128104 Continued

Facility Number: $ a -aq Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eallo ❑ 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes C'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 (9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No CR NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
1�hNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CRNA
❑ 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
ff 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
W 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
9No
❑ 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
NTNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
S`Fi I I or_ M 0+ of boe s-ro� &n l a� Walt n erl- ei h as �ej ,. Plese a cd -era;
1 irn e� s��ys orseP�,a- DIV �� s�dQ o� 1 a�oo, i � l oo sir y ..
15'b e need I Im , PWAA i� 4o l Ptine -ice i s --Pa 1 J aboi - 1 U1 /at e ,
(, �VIeed,so;1 *eA b,49710
r
sltid e yvar haJe,t p-K-aoo8 anewskd e s✓tee dark,
-Ford aoo� , W­piew mall.
0) AsiVA O rva SO4ti17- A Pram- A�3n: Uoen
far �
sidef7ea~,1a, jo&) Ca,er noW- in 4P-) J� loekl j `':h ' well kL
Rye. 01WAdej f) Bile
Page 3 of 3 12128104

Facility Noq 614 i Farm Name CH t Date
Permit ✓/COC OIC_ we NPDES {Rainbreaker PLAT Annual Cert )
FB Drops
--I
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
�S
,
Observed freeboard in
Slud a -Survey Date Perm Liquid (ft)5
Sludge Depth ft
Design
,Z��-------
Soil Test Date 44 " W". "" Cg pImn � 1*11*e_
__y_-Old 1 in Inspections
pH Fields }� Crop Yield 120 min Inspections
Wettable Acres ���
Lime Needed YP11 E-j Weather Codes
Lime Applied WUP Transfer Sheets
Cu Zn Weekly Freeboard RAIN GAUGE
Needs P Rainfall >i"
DID
000
•
y
,
Pull/Field Soil Crop RYE PAN Window
aar -
1>61
7
-I& eILA
ico
I-S
venry FHUNt Numt3tK3 ano arrotations pjp�yjbrpr6� 7e
Date of last WUP FRO Date of last WUP at farm App. Hardware apel Max RateO.40 Max Amt O,Qf
Top Dike��-
Stop Pump /L q(6vz7
Start Pump

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I j �I l Arrival Time: f Z Departure Time:
Farm Name:"
Owner Name:`'-�
Mailing Address:
Physical Address:
County:
Owner Email:
Phone:
Facility Contact: l ' ` c Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:�� - Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Q e F—I f 0 " Longitude:
Region:
Design Current Design Cur'reat DesigSPER
urren#
[FEE]
wine Capacity Population Wet Poultry Capacity Population CattleCapaculation
as
ean to Finish ; ❑ La er ❑Dai Cow
ean to Feeder ❑Non -La er ❑Dai Calfeeder to Finish a �� y^' ` ❑Dai Heifer
arrow to Wean �;R� ❑ D Cow
uarrow to Feeder r* Non-Dairyarrow to Finish ❑ Layers
El Beef Stocker
El Gilts Non -Layers
�� El Pullets El Beef Feeder
El Boars ❑ Beef Brood Co
.' a ram: w4_ ❑ Turkeys y
Otherµ
❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
t No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No X NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ,C,?FNA
❑ 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
tN�*A
❑ NE
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes(ff�o NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No DCA
El NE
other than from a discharge?
VV
Page I of 3
12128104 Continued

o
Facility Nqmber:U-0311 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier-
Spillway?: ff
Designed Freeboard (in): i 4—b'ti` ed 9 IHS ra, l a j 1 L—)vS
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No � NA El NE
Structure 5 Structure 6
❑ Yes rZNo1
❑ Yes I)R)No
❑ NA ❑ NE
El NA El 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? f Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 151 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
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift Outside of Area
12.
IWindow
y❑y�Application
Crop type(s) G T S f I 1 "P W
13.
(ns `` 11 J��{
Soil type(s) 0` , � y 1�1 � l N (l A
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
KNo
❑ 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
W No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
jR No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
VNo
❑ 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):
- V:w 1Z o-YeAs 5110u dc.QOd o �t ,:2•c os�(9��
Mn t `�o�p 50 y Shy I� Loom', � S url
Reviewer/Inspector Name wr Phone: ju
Reviewer/Inspector Signature: Date: c t4, Zooms
12128104 Continued

Facility Number: Date of Inspection U777
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yietd ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes IN,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No �&NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1QNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[:]Yes
JQ; No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ 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
P1 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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
N 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
El Yes
j
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J9 No
❑ NA
❑ NE
Comments and/or Drawings:
I2128104

N
n1 "Z—
Time Out
Date / Z r
Facility No, .
Farm Name
Owner
Operator
Integrator
Site Rep
No.
Back-up No.
COC Circle: �enera or NPDES
Design
urrent
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
— inns
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey q•�`
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Me Nitrogen (N)
2.
Observed I
Calibration/GPM ub I s
Waste Transfers`
Rain Breaker ~`
PLAT
1-in Inspections
Date Nitrogen (N)
n
Q1% 7 / c�
46
Pull/Field
Soil
Crop
Pan
Window
1
GL
Zo
-
a-r
Wa g
a
w
v`
v

Type of Visit
ecompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
@4outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other Cl Denied Access
Date of Visit: rr�t� Arrival Time: Departure Time: County: S13\,
Farm Name: N Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
P12
Facility Contact: VAQ l Title: )-)(1%I( _ Phone No:
Onsite Representative: Integrator: ' r ' �.ra&r�
Certified Operator: �� Operator Certification Number: 3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 Q = t = « Longitude: 0 ° 0 4 = p
Design Current
Design Current
Design Current
Swine
C•a aci Po nlation
Wet Poult .
C•a aci Po ula 'on
"Cattle Ca aci Po elation
❑ La er
❑ DairyCow
❑ Non -La er
❑ DairyCalf
❑ DairyHeifer
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cow
Other
❑ Turke s
❑ Turkey Poults
.._
�.
9°
❑ Other
❑Other
i yNumber of Structures: ',I
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish
�}--
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
. 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?
b. Did the discharge reach waters of the Skate? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of
Region:
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
[X NA
❑ NE
❑ Yes
❑ No
Qi6IA
❑ NE
-all
❑ NE
❑ Ycs
❑ No
❑ Yes RNo
❑ Yes P No
❑ NA ❑ NE
El NA
❑NE
11/28/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4
❑ Yes N No ❑ NA ❑ NE
❑ Yes ❑ No [ja NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): r'
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes k 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 P$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 O� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ANo ❑ 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 WNo ❑ NA ❑ NE
maintenance/improvement?
H _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes _[;�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E Application Outside of Area
12. Crop type(s) 2". M U d-SlIL44 A C�� , -'sm (� t d S r Ck 1 M . R%- W Ofr ..
13. Soil type(s) �Ra WA
�� ND A A U v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C9 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
[]j No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
N; �e Sao. l • LQ o..i i 's-5e-e Loam S-po s cr} �rn�0.n�Gn�r1
LcxcsA� pla., %�orP �1rn�;�� an
wife c rbe5 are To 16-Q ehar7 yal
ReviewerA nspector Name ; #.Q ST1 ,A VQ7_0N Phone: `133
Reviewer/Inspector Signature: Date: 2 ?]l1
Page 2 of 3 12128104 Continued

Facility Number: `a µ Date of Inspection. 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �gNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes,-�M 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 &�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Wo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PIN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'�NNo
❑ 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
DNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I�LNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ESNo
❑ 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
%0 No
❑ NA
❑ NE
General Permit? (ieI discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JP No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
bNo
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12128104

I
Facility Not . Time In � + Time Out Date (,Q c�u 0 6
Farm Name 0 Integrator
Owner _­o, Site Rep
Operator
No.
Back-up No. -
COC Circle: General or NPDES
Desi n
Current
Design
Current
Wean - Feed
Farrow - Feed
-
Farrow - Finish
Feed -Fin'
Gilts 1 Boars
arrow - n
Others
L�
FREEBOARD: Design i Observed
Sludge Survey a� Calibration/GPM ✓ 1 ��
Crop Yield Waste Transfers
Rain Gauge �~ Rain Breaker �-
Soil Test PLAT L- Wettable Acres
Weekly Freeboard Daily Rainfall 1-in Inspections �—
SpraylFreeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
�-
Date Nitrogen (N)
i_7 Z .
! ` 4 r uv—
�■��w��.�'�►��
r�
f ter'
�r
��

S�
o

of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Omer ❑ Denied Access
Facility Number
JD"teorvisit: i'70•o Time:
$ �q
O Not rational O Below Threshold
�rmitted MC!ertrfied 13 Condition/ally Certified 0 Registered Date Last Operated or Above Threshold: --•• .
Farm Name: �_.. .... County:
_...
Owner Name- _- -a ....._._.-....Q>1 Pit G _ _ ....//� ._ .._ ... Phone No:
Mailing Address-
.._/ 0 .. Qc�r�.. .•9�v _ .__ Sc'�rasS � _ AI C -2
Facility Contact: ------!3`sl�__f�,,� s.Y>s` Title:Phone No: _^ "
Onsite Representative: ------ [ atn _ ._ .. Integrator: Ate-.
Certified Operator:.„ . (, ...... Operator Certification Number:. l J`. _&__.__._.
Location of Farm:
�I
03Grine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �` ���
•- Curre
,7�wtne Ua tact =µPo uiatiow_=
Wean to Feeder
er to Finish
y
Farrow to Wean
Farrow to Feeder
El Farrow to Finish
Gilts
LEI
Boars
� ':Current
atv =Population -cattle : Caipacitt
I�lumber of Lagoons Y
�r
r.,i
Dischar>?es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M.Wo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Qwo'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes E�M
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes B-M7-
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9-K-6—
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [3-146—
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 92Jaie—
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -..... �.... .............. ...........
Freeboard (inches): n
12112103 T Continued

r Facility Number: tr:X Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes !moo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes M41o�
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑-I
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes 01G0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [-}fqo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑-No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes B-9
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type iJ�vrni✓�c . <in., /r' rrr�r,n , Ceii�vn , C
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVMP)? ❑ Yes EINO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 944t)
b) Does the facility need a wettable acre determination? ❑ Yes 9-1-
c) This facility is pended for a wettable acre determination? ❑ Yes GNP
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑M
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes DIo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes G-1W
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes D+W
Air Quality representative immediately.
Reviewer/Inspector Name h1av
]!
Reviewer/Inspector Signature: 1137 Q — Date 7 moo-y
12112103 Continued

Facility Number: 12!it Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑44v-
22. Does the facility fail to have all components of the Certified Animal Waste Management flan readily available?
sts, qm6, nwW, etc.)
❑ Yes
E5.Alo-
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U Ala —
❑West ❑ Freeboard ❑ ysi ❑ In
24. facility in Jteiia in the time design?
❑ Yes
Q-Nb
sI not compliance with any applicable setback effect at of
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
e1q-
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
E#a-
27. Did Reviewer/Inspector fail to discuss reviewrinspection with on -site representative?
❑ Yes
9-N6
28. Does facility require a follow-up visit by same agency?
❑ Yes
GNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9+fa
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes &W
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103