310776_INSPECTIONS_20171231

NUH I N LAHULINA
Department of Environmental Qual

Type of Visit: Wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 5noutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l 2et Arrival Time: ® Departure Time: ® County: Region:
Farm Name: � I.k l Aa.jrSL a4ja Owner Email:
Owner Name: ,� e C L_"t u L- c . Phone:
Mailing Address:
Physical Address:
Facility Contact: ( Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: � L9U 0 2
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pap.
Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dai Cow
Feeder
Non -La er
DaiCalf
o Finish
2
Dai Heifer
o Wean
Feeder
o Finish
E
Design Current D Cowo
Dr, P,oultr, C:a aci P,o Non -Dairy
La ers Beef Stocker
Beef Feeder
Beef Brood CowOouets
Other
Other
Non-Laers Pullets
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes iX I No ❑ NA ❑ NE
[:]Yes
[:]NE
[:]No [:]NA
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE '
❑ Yes � No ❑ NA �] NE
Page 1 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ 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: k
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [XNo ❑ 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 bd 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 4No ❑ 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 4No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EXNo ❑ 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 kNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
b No
❑ NA
❑ NE
❑ Yes
06o
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, chec i the appropriate box below. Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis C 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 'k No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: lejj Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes
[ No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
XNo
❑ 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
$iNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
❑ No
0NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes X No ❑ NA ❑ NE
❑ Yes t No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes XNo ❑ 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 9No ❑ NA ❑ NE
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Reviewer/Inspector Name:YOIS'6 Phone: I Q MM` 7 5 H
Reviewer/inspector Signature: Date: 2
Page 3 of 3 21412015

3 ( ICI 776
Type of Visit: p Con fiance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ( Arrival Time: Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,Ti�tle: 4
Onsite Representative: t—_* J /' C L `// [
"' I � C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: r G k 0
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
11
Wet Poultry
JLayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
INon-Layer
I
Dairy Calf
eder to Finish
74
D , P,oultr,
ILavers
Design
Ga aei
Current
P.o _.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
Qther
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes To ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NoDNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E3No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: --2 7 4 jDate of Inspection:
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): Z-1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E]-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E:r—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 21 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ❑ N
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E]-)qo
❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ENo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2T5,�-
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
[DNA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
D NA
❑ NE
Page 2 of 3 21412015 Continued

IJ
Facility Number: jDate of Inspection: `i /6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [r No ❑ NA ❑ NE
❑ Yes [!fNo ❑ NA ❑ NE
[:]Yes LLJ No ❑ NA ❑ NE
❑ Yes Cf No ❑ NA ❑ NE
❑ Yes [!j'No
❑ Yes ZNo
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: - -- -—� Date: fA e,
Page 3 of 3 21412015

Type of Visit: Q"Co nee Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
IY
r
Date of Visit: 9 S Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: L{ 5 (rL L.-H. R Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Currentmolgn
Capacity Pop.
Wet Poultry
La er
Capacity
Current
Pop.
Design Current
Cattle Capacity
DairyCow x
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
3 Z S3
Dr, $oultr,
Design
Ca acit
Current
P,) ,
Dairy Heifer
Dry Cow',
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qthcr
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes,
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: jo
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 3<o ❑ 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 [21�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes U 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 ENo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ 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 [!J No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [3/No ❑ NA ❑ NE
r
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No,
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E-No
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:,,-
21. Does record keeping need improvement? If yes, check appropriate box below.
6"Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ff o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection
24, Di41 the facility fail to calibrate waste application equipment as required'by the permit? ❑ Yes [3-No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ErNo ❑ NA [] NE
the appropriate box(cs) 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 ❑'Nil ❑ 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
© o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes�N�-NA
NE
34. Does the facility require a follow-up visit by the same agency?
❑Yes
o ❑ NA
❑ NE
Comiments. (refer toque`stion #)%%;Explain,"ri tyYES. answyppers`{{and/or,any�addihogn-iii i commendations nr aany other cojmftig6ts.'
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Reviewer/tnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 o?4 7 3 0'y
Date: I OA gr ' 5
21412015

Fype of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine �� Complaint � Follow-up � Referral � Emergency � Other O Denied Access
Date of Visit: M y Arrival Time: I , a °6I Departure Time: County:
Farm Name: 1-AAu-S /AQasf1 r14 _ftA Owner Email:
Owner Name: L4 G H i �-TE Phone: Mailing Address:!) H -+ NC S S I f L &A"VT () to LAC A c_ ^^ p2
d d J C0S
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Intor:
Lb 5-
Certified Operator: [S t.l 1ti-. �� 1� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
I &boa ---
oilDesign Current
Sne Capacity Pop.
Wcan to Finish
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
can to Feeder I
Feeder to Finish
INon-Layer I
Design Current
D , P.o_u1tG Ca aci P,o
Layers
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turke s
ITurkey Poults
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?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE .
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - -4 Date of Inspection: IMS11=
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: ti
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes }� No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ,7�1
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable' Crop
�Window ❑ Evidence
rof. \Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Sly 112o- Lbw W 064'T <!{ s
13. Soil Type(s): %y[]U-0C-r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes KNo ❑ 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.
Q WUP ❑Checklists 0 Design [] Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No
Q Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
0 Rainfall ❑ Stocking Q Crop Yield E] 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili -Numb r: - Date of Ins ection: j1jQEj1Lj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 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 rO No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional 1recommendations or any other comments.:
Use drawings of facility to better explain situations (use additional pages as necessary).
UO.A.
00
sl���►y a.a�
7 0o 13
� z:c
'5auc� D
LA6009 1416 rN
PAU !R.5
Reviewer/Inspector Name:
I L 60Lj S FO& �c9_C KAl/ i V � uc�
- wG(� �� r a,F tCl_ y-{�-ir`
/NE
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412014

type of Visit: PTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
lesson for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — - " Arrival Time: JAM Departure Time: County: �_ Region:_
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: L-PA k RAAAA
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: nn
Certification Number: `�U
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
besign Current
Wet Poultry Capacity Pop.
Layer
Design Current
C*attle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 [7No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
. 0 Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,61No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued FAA

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ 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 VT 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 YrNo
❑ 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 ZNo
❑ 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 o
❑ NA
❑ NE
maintenance or improvement? (T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;a 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? T
17. Does the facility lack adequate acreage for land application? ❑ Yes VrNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes P No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ YesIn
No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes P!fNo ❑ 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 A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 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: r --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ';E�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;3'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 WTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes )fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
g6No
❑ 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
VfNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
4KNo
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
9No
[3NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;21 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othertomments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:'
21412011

(Type of+Visit: Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: I& outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: / County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: LF
I
Certified Operator: r S&I
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certir,4 o Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design
Wet Poultry Capacity
Current
Pop.
Design C*urreat
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -Layer
Dairy Calf
DairyHeifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design
D , P,oult . Ca aci
Current
P,o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Yeso
ko
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Fariti Number: - Date of Inspection:91-3//QL
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 I 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 X-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 o ❑ NA [] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes )kNo ❑ 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 ko
❑ 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 r ❑Cl"�viideencce oft Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S6 � Lfli�J OT S 1J
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.
❑ Yes No ❑ NA ❑ NE
❑ Yes I ❑ NA ❑ NE
❑ Yes i No [] NA ❑ NE
❑ Yes V_VNo
❑ Yes 4co
❑ Yes No
❑ Yes A
No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
©WUP Q Checklists Q Design Q Maps []Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ 1yaste Tr nsfers 0 Weather Code
Q Rainfall 0 Stocking ❑r Crop Yield Q 120 Minute Inspections 0 Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ 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 ro ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yeso ❑ 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 \D�No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
�kNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
[3NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
an
t�J
Cw�DS A L -r TO
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: C,Ja Region:
Farm Name: 1-\aL(_ s ff)Ay_S N FAwm Owner Email:
LES CI E t nL � w�Q�19-(o S�= ��IcSCo
Owner Name: {'�1l ` Al �}/�j /�� Phone: n /- S
Mailing Address: o� t "1 ! V C � r . ! + ouly % OU qrz. / ,- 3 od s s(g S _
Physical Address:
Facility Contact: r *Title:
Onsite Representative: LCSC-i C
Certified Operator: L_CS Li 6-
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 112%.QQL ._
Back-up Certification Number:
Latitude: ❑ o = 6 = Longitude: = 0 0 i = 1{
Design Current Design
C*urrent Design Current
Swine Capacity Population Wet Poultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish 1
❑ DairyHeifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La Layers
❑ Beef Feeder
El Pullets
El Beef Brood Cow
❑ Boars
❑ Turke s
Other
❑ Turkey Poults
❑ Other
10 Other
Number of Structures:
Discharses & 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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
12128104 Continued

Facility Number:Date of Inspection 4 /d
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: L4 c-, 00W
Spillway?:
Designed Freeboard (in): Q r
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 ElNA ❑ NE
ElYes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situationposes an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ 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
J No
[I NA [3 NE
maintenance/improvement?
►'
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9No
❑ 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 ❑^�DEvidence of-- Wind Drift ❑ Application Outside of Area
12. Crop type(s) S (Z Q F. �Z-. C___WqPt6A-T S'?�'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[f No
❑ NA ❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
*No
❑ NA ❑ NE
p ..wl N�»?:. ,-0 �R.`i3Y d'�Cix B.dJ ;lw.}Ym( .: . x n.a.:z.'i�'i_±. ,CAI.' �.y.0 }.:T. �M.�. sd.9 b�. 74:: .�fl�S <.� Y�?:��
Comments refer to uest�on@@# . Ex lam -an. YES:answers#andlor�an =recommendations or, an other comments. w
. R's '.Y. S.p§r : hE ,.h'.: 9X4 .:M A g III �Pg 6�I}'4gr;k�' VX 44R
Use drawm s of tacilit toAbetterr ex lain=situations use add►tranal> a es<as-pecessar �_ :�: m
g 1�a Y n �P
8 0 6 Z -_.
11
Reviewer/Ins ector Name ' �" '' 210
P c YJU - S €. Phone:
wl11 ,lit
Reviewer/Inspector Signature: CKIYLIrJ Date:
Page 2 of 3 12128104 Continued

j.Faci!itX Number: 3 j Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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. 0 WUP El Checklists
0 Design El Maps El Other
❑ Yes No ❑ NA ❑ NE
❑ Yes 110No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ /aste Transfers ❑ A/nual Certification
0 Rainfall],Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ;No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ YesNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes ❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
^ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
4No
❑ 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
4No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fidNo
❑ NA
❑ NE
AYdditionalCommentsland/o© ,Drawings t
w A-
a S 16N r IN (366 lNiV//VCi 0 rr AAGk
CAUU,4-'I0N DtAE- oDOl 1
%�f l� To C �"i' L A�ao Al P k M D DO w Al I11/ P 12 A T�oN O
puqAU Gt4N e Se A 5 o/u
Page 3 of 3 12128104

Type of Visit rMCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit &outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: j1� �] Arrival Time: Departure Time: County: u Region:
Farm Name: 1: �A�-L?5H ��� M Owner Email:
C_IC Wt4177C-� qq ass (i�a3<<
Owner Name: Phone: 919
Mailing Address:
Physical Address:
Facility Contact:
Title:
I= w � �
Onsite Representative: I�7 t � l T?
Certified Operator: L esLAc 1-. �H t TTr
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: oa
Back-up Certification Number:
Location of Farm: Latitude: 0 e = & ❑iA Longitude: = ° = 1 0 "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Paultry Capacity Population
C*attle C«apacity Population
❑ Wean to Finish
IEJ Layer I
I
❑ Da4y Cow
❑ Wean to Feeder
❑ Non -Layer I I
❑ Dairy Calf
ZI Feeder to Finish I Cc3� L C3
❑ Dairy Heifer
❑ Farrow to Wean
Dry Paultry
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dal
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
ther
Number 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 bo ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
to
❑ NA
❑ NE
El Yes
[I NA
❑NI:
12/2"4 Continued

Facility Number: —
Date of Inspection ti 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA(WoN
Spillway?:
Designed Freeboard (in): 19.5
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 managcd
through a waste management or closure plan?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes V No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 �To ❑ 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
XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Se; Q �t _& y C:)gAl ��ffF 9T S
13.
Soil type(s) &(LFGL-lc
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No ❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
( No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
i� No ❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any1YES answers andlor,'any t`ecommendationsorany other comments.
Use drawings of facility to abetter explain situation`s. (useadditronal pages,as necessary
404
Reviewer/Inspector Name -- II�N� ��q:!!Vt"B S. T t «k� ':' Phone:�(!�gtn-�'
s . a' r �.„ I is
Reviewer/Inspector Signature: `� . ct;► Date: 1111,11 a9
12128104 Continued

Facility Number: Date of Inspection 09
Required Records & Documents
19. Did the facility fail to have 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. 0 WUP C1 Checklists 0 Design 0 Maps El Other
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 3 Waste Analysis ❑ Soil Analysis ❑ Vste Transfers ❑ A/hual Certification
[D Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute inspections 0 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
i No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
)klqo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ 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
I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
N
❑ NA
ElNE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
b No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
W.A
`
W1 O fA G
12128104

1�, W Division of Water Quality
r /
y i agility Number 3� �p Q Division of Soil and Water Conservation
--
D:Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: L� County: LI N Region:
Farm Name:
Owner Email:
Owner Name: L fr S U E V • t J 3 L4 1 'ICE I� Phone:
Mailing Address:
Physical Address:
Facility Contact: n .11 Title:
Onsite Representative: rest-i C `` • (Wt-i i T l
Certified Operator: Lr; Su C ,4 ' W H t TT F_ r
Back-up Operator. _
Location of Farm:
Swine
' ❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: =o
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
=" Longitude: 0 ° =1 0 6f
Design Current Design Current
Capacity Population:: Wet PoultryCapacity Population
❑ Layer
. 0 Non -La er
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?
Design `- Current
Cattle Capacity, Population
❑
Daia Cow
❑
Daia Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
I
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes &No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
❑No
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
El NE
12128104 Continued

Facility 1iumber:j 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 I Structure 2 Structure 3 Structure 4
Identifier: LA (�nw
❑ Yes ANo ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?: n
Designed Freeboard (in):
Observed Freeboard (in): O�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes YNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes eNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes \lrsl 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) 1
❑ PAN ❑ PAN > 10% or 10 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes fi�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 91 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
11
❑ 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 XNo
❑ 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):
I
Reviewer/inspector Name _ flr / S 1 Phone: 0-l4�— 3D
Reviewer/Inspector Signature: �&5 Date: o� 3��
Page 2 of 3 12128104 Continued

"Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ko ❑ 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 A 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
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
<No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
19NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
A°d"ditiiinal Conimtnt`s anlltir" Dravi?inpps i "' ` yyii ( "' t " yy g
f ... .t n'.E-�r?'�' ?�- .� �`:S &'�;;�64;i ?.'7 -t
i
T
Page 3 of 3 12128104

Division of.Water Quality
Facility Number: '„ ��]� Q Division of Soil'and Water Conservation
Q:Other Agency
Type of Visit c�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (� Routlne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0 3 d Departure Time: County: LUPO-Za J Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = I = Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
FEI
Layer
[Non -Layer
I F==l
r�
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: F1
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 E No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ NIA
❑ Yes Lf I N
❑ NA
❑ NE
❑ Yes LYNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — {, Date of Inspection o
Waste Collection & Treatment
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3 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: (A6,061pi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
14 Yes
❑ 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)
4. Does any part of the waste management system other than the waste structures require
ElYes
CI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
//
9y o El NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
JJJ
❑ PAN ❑ PAN > 10% or 10 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,El
L✓J No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
N El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El
No ❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
`].) BALK CA"N t7R- of vs�� W)AC-t— M"OS Ga'*W WW
NEB/ v) L/ P D W6
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ad
12/2R/!14 Continued

Facility Number: — Date of Inspection
REguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L'1 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
❑ Yes �No ❑ NA ❑ NE
❑ Yes EJ No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Eg
7
El NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LXNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 1;90 ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes C14o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes �o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Cj No
[INA
[INE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes ZNo
❑ 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
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
WIo
❑ 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
94,
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
&l No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

dDiv6ion of Water`Quality'
Facility Number' '3 '� Dwision of Soil and Water Conservation
--- �; Other.Agency;
Type of Visit {fJ C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit K1 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Cl Denied Access
Date of Visit: /0 G vrj Arrival Time: Da Departure Time: County: p1Yr.� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone No:
Onsite Representative: LFS LZE LJ �� TTE O Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = A = es Longitude: = ° = 6
Design Current.-. Design Current:„ Design-. Current '�`
Swine Capacity Population' Wet Poultry. `'Capacity Population Catfle ,Capacityr PopulatIow-
1❑ Wean to Finish
❑ Wean to Feeder
Fel Feeder to Finish 6U i
❑ Farrow to Wean
i
❑ Farrow to Feeder
❑ Farrow to Finish i
❑ Gilts i
❑ Boars
Other
❑ Other
❑ Layers
❑ on -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ 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?
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures ; r
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 wasie management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Mo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
YWN
❑ NE
❑ Yes
❑ Yes
o ❑ NA
❑ NE
❑ Yes
o ❑ NA
❑ NE
12128104 Continued

e
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 lStructure 2 Structure 3 Structure 4
Identifier: (A fs w ! r
Spillway?:
Designed Freeboard (in): 1 g S
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 �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 9NNo ❑ NA ❑ NE
❑ Yes 040 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thrgat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �—�Z ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U(No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) +3C P v S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑l Yes No [INA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Eyes ❑ No ❑ NA ❑ NE
16. Did the facilityfail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes dNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [�] o El NA [I NE
18. Is there a lack of properly operating waste application equipment? El Yes LJ No ❑ NA ❑ NE
Comments {refer to question #):' Explain any YES answers and/.or aay,recommendations or any other: comments ° -
Use drawings of facility to better explain situations. (use additional pages' as necessary)•;'
rs,) J3c-+ m(joA 06603 Cv ^1TCIU6/6-b
wEkA ConlnX.OL d1 Lbt O� rotteXC
-
G-2R'sJ,
Zv,) W v0 Wt✓ 6 P S To 19E R &V-rSE 9 76
DV V'OC- "1(-/V 1-W 17'5V r�01 U,
CIn.4) wA s P&A PIMPISvT X4o
�a . SFA AiV t Z cR 7?wf✓�
rd py t;
.
_
Reviewer/Inspector Name
__ h
Phone: 9w e 1f
Reviewer/Inspector Signature:
Date: f
Page 2 of 3 v 12128104 Continued

Facility Number: — Date of Inspection ib dv J
Required Records & Documents
N. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Y s C�No ❑ NA ❑ NE
20. Does the facility fail to have a 'omponents of the CAWMP readily available? If yes, check �es ❑ No ❑ NA ❑ NE
the appropriate box. �p ❑ Checklists ❑ Designn❑ Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
�N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
ElL]
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ 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
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes❑
VN
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
To
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
2 No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit It Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /! D Arrival Time: ,'DO Departure Time: County: 1�ARegion: sell )
Farm Name: %7`%��—LS / r %ili� &a) Owner Email:
Owner Name:z ____ �iV/i�%''T7FD Phone:
Mailing Address:
Physical Address:
Facility Contact: / r Title:
Onsite Representative:�5/y?� fi�JTTf.�
Certified Operator:
Back-up Operator:
Phone No: Integrator: A6V.. �15ry / i ,C
l0.,,,_,.,..,..,,..-----
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =e ❑ 1 ❑ Longitude: =o =, = H
Design Current Design Current = Design Current
Swine Capacity Population Wet Poultry Capacity 1'opMuatili Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dai Cow
❑ Wean to Feeder
Non-Layet
1 0
Dairy Calf
Feeder to Finish
❑
Dry Poultry ❑
El
❑ Layers
Dairy Heifej
Farrow to Wean
Dry Cow
❑ Farrow to Feeder
Non-Dairy
El Farrow to Finish
Stocker
Gilts
Non -La ersPullets ElBeef
ElElBeef
❑
Feeder
8113oars
Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes /No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes 0 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: —(Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ;
Spillway?: O
Designed Freeboard (in): �Q.S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes A No ❑ NA ❑ NE
.through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JO No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes WNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) `, c,'elf' a,O4_ 1:�VgA1U5 _6 //Afl �iCr, ��di-� :�f.A�__ y6w5- &V
13. Soil type(s) 10OX
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 Z 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?
/Z
❑ Yes VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
1000Wk 6gZt =OG��� 3 l.✓ Gzir+f�/� j1/ ,Dr�D�42
60":: 4014 �2� L ,o, c As �ffp G2rr,F v G��.� 7.
Reviewer/inspector Name ;�X`a�h� K,�ti��. Phone:
Reviewer/Inspector Signature: Date: r kv
12128104 Continued

Facility Number: / — (j Date of Inspection r
Renuired 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 Q� No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes )�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
'izNo
❑ Yes ❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
` 27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
KNE
Other Issues
`
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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 XN o
❑ 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 /21 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes JffNo
❑ NA
❑ NE
Additionai'Gom en f .. nndor Drawings
i ��/t'Gi� ,End B O/AQ2o EA ,�A1G, ,:J� 0
7'r, ZA) 4 r�� I� �� Ir 7 �iU �iiC1 �il2�J �r,/ �Zl 'lam �/�/Cr
qj,#105 5 4X, 44Z & `a5W l4e9;c-
0��
350_
12128104

08i12/05 09:40 Fax
t-It` Fax Note 7671 D-w p&'gesl'�
r
-Mopt. Co.
Rainman Envir_o=ental, LLC
Post Office Box 115
Kenansville, NC 28349
910.271.0460
Irrigation Equipment Field Calibration Form
Farm Name
Leslie Whiffed
Date of Field Calibration
2/16/2005
Flow Meter Serial Number
M051313902
Equipment Number
Cadman SN 0089033000W8
Measured Ring Size
1.172 Inches
Is ring size within 0.01" of original
manufactured size?
x Yes or No_ if "no," replace
nn .
Pressure GaMe Readings.
At Pump
2200 RPM 1222si
At Traveler
Psi Of licable
At 5 ' er/Gun
50 Psi
Expected Flow Rate (from manufacturers
204.5 GPM
chart
Measure Flow Rate from flow meter
205 GPM
Flow rate variance ffeater than 100/6?
Yes or x No
Expected Wetted Diameter (from the
292 Ft.
wetted paMe determination
Meas<ired Wetted Diameter
300Ft.
Wetted diameter variance greater than 15%
Yes or x No. If `Yes," then
and/or measured flow variance greater than
contact a technical specialist or irrigation
10%
dealer for assistance. Explain findings in
box below.
Explanation of Findings:
Calibrator's Signature:
Itzip ion Equipment Field Calibration Form 8-15-03
Retention Period: 3 Years Origin 2

Type of Visit ifCornpliance inspection O Operation Review O Lagoon Evaluation i
Reason for Visit Q�Aoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility NumberEiT3__=
Date of Visit: I
Pfermitted,eCerttifed © Conditionally
Certified 13 Registered
Farm Name: .. ...0�aria..............................................
=�] Time /0
Not Operational O Below Threshold
Date Last Opera..d or Above Threshold: .........................
County:........................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
MailingAddress: ............................................................. . . . ................................................... ................................ _................................................... ..........................
FacilityContact: .............................................................................. Title:.............................................................. Phone No:...................................................
OnsiteRepresentative: ..................................................................................................... Integrator:..r.l.' ' u/M......................................................
Certified Operator:..L. eJ//._Z ....c11,71Aetr,,,,l............................................ Operator Certification Number:..........................................
Location of Farm:
G'Swine ❑ poultry ❑ Cattle ❑ Horse Latitude ' ' G9 Longitude • 6 94
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2,f4o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 040
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............l............................................................................................................................................................................................
Freeboard (inches): �b
12112103 Continued

Facility Number3% — 7j Date of Inspection
5.. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes -PIKo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes z No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
..7. Do any of the structures need maintenance/improvement? ❑ Yes ZINO
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �10
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �To
elevation markings?
Waste Annllcation
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 ONo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with%ose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 2Vo
b) Does the facility need a wettable acre determination?
❑ Yes Qfilo
c) This facility is pended for a wettable acre determination?
❑ Yes 0 No
15. Does the receiving crop need improvement?
1201yes ❑ No
16. Is there a lack of adequate .waste application equipment?
❑ Yes 2<0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes An&
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes �io
19. Is there any evidence of wind drift during. land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes 'Er50
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes [],No
Air Quality representative immediately.
Field Conv ❑ Final Notes
121pGJ-e )--)e Sc«e -le I-ja v-e 1;-"7c1�r1e00e
o �ou ✓ __� Ala /
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: ,5 /1 <-14 t
12112103

Facility Number: Date of Inspection
b
Required Records & Documents~
21. Fail to have Certificate of Coverage & GeneraI Permit or other Permit readily available?
—La-If es
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑Yes
gNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
12�o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
8'No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
_F o
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
['10
28. Does facility require a follow-up visit by same agency?
❑ Yes
.[1T0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
P"fes
❑ No
31. 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
O*Iqo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
El No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
0l0
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
No violations or deficiencies were noted during this visiti You will receive no further correspondence about this visit.
4 •-•..,�.._<,: �.re�f.vs..e.ts�„ ...� ,.....Y <„:-: _: e�eva..✓ ) -., .,.. S sp 3' i:" °'.. h ve . .. f PI° rs 6Es F4 :-.., 11 °� g,.� 4ka,
. , � S t € €-.okr'y
ddihonal Cominepts:artdlorDrawtn s:EL IgE:r Y:-• , t,a; .,r Its �.R s..
i-�� jt� "t, .:f:d,33§3 ��u}rial .a�51 .-, .+Si, ..�._m.:aLa� �[na
1P�Se )n c/crcP, 776w Gopl —Si 1 e co IZD15
A,
12112103

Type of Visit O Compliance Inspection O Operation Review Q'Cagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time:
Facility Number
Not O erational 0 Below Threshold
©Permitted 13Certified 0 Conditionally Certified [3Registered Date Last Operated or Abov
D Threshold:
Farm Name: / �/ / County:
Owner Name: ` . /1 . 4x) 1 Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° OK Longitude • 4 l�u
Design Current
Design Current Design Current
Swine Capacity Population
P ultry
Capacity Po ulation Cattle Capacity Population
❑ W to Feeder
JE1 Layer
I
I I JE1 Dairy
ecder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
-.
❑ Farrow to Feedcr
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of LIigoons.:... 0I.. ❑ Subsurface Drains Present ❑ La oon Area JE1 Spray Field Area
olding Ponds 1 Solid Tra s y ❑ No Liquid Waste Management S stem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (lfyes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — �7 Date of Inspection 74
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an .
l.r
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? 1` ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAIk`MP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Re uired Records & Document
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DIA'Q of emergency situations as required by General Permit?
(ier discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,p
.:- ,'�..r-� '-� .rd,'e* -Alf
Comments,(re€er to'gn�an 0)..Erp1dn.say YES`ar�swers!and/or any recommendiidons.or sny, other comments: �I �,
>l•Jse drawrngs of facility to better ezptam situations.-, (use additioynid pages as yn a4ry):,.'r t ❑ Field Copy ❑ Final Notes
..i.t_J..• ".�L�.sA:S:�t .�-'.. .w:�l.a1-..+.... �i�4.S�.'1.Y1at:.i.w^.:+L"..F...n;.YGi:''�',�Tk�iJ•FlstYe C'xlr,.... 9,�'1 "4wn—.wv„r�+..z�r.�-•. �.'C
�/;`7 Po��drnr C �x
n raj€ 7
ReviewerllnspectorNamg�.-.�
«��'�
r
Reviewer/Inspector Signature: Date:
05IV3101 ✓ Conddnrted

Type of Visit ?ICompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit!% 91 Routine O Complaint Q Fallow up O Emergency Notification Q Other ❑ Denied Access
F_ 10 Facility Number Date of Visit: Time:
Not Operational 0 Below Threshold
0 Permitted �Ceified 0 Conditionally Certified © Registered Date Last Operate or Above Threshold:
Farm Name: &4 D County -
Owner Name: �F�i�_G �5 Phone No:
Mailing Address:
Facility Contact: Title- �f j�p,Q , Phone No:
Onsite Representative: L!�'SL.Z � z-rF� Z Fn ' 2 � T ILgrator: ✓�
Certified Operator:
Location of Farm:
Operator Certification Number:
Zf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Da 06 0" Longitude '
Design Current Design Current Design Current .y
Swine Capacity Population Poultry Capacity Population Cattle Capacity- Po elation
❑ Wean to Feeder 10 Layer FE]Dairyj
Feeder to Finj! JEJ Non -Layer JE3 Non -Dairy
Farrow to Wean I - --- -- — '
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish: Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Holdin Ponds / Solid Traps ,, �i ❑Subsurface Drains Present ❑ La oon Area ❑ S ra Field Area
Number of Lagoons ,,;
'g p ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes W(No
Waste Collection 8& Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): JV
05103101 Continued

Facility Number: 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
O No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
//
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
[:]Yes
16No
11. Is there evidence of over applicatio 9 ❑ Excessive Pond�ingg ❑ PAN Hydraxerload
Crop type fl s �/
�Y ss /❑ N12.
dw
91
13. Do the receiving crops differ with those designated in the a ified Animal Waste Management Plan (CA )?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�No
b) Does the facility need a wettable acre determination?
El Yes
VNo
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ YesXNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
YNO
Regui ed .Records & Documents/No
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
(L1 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
/ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
,1No
ILI No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) °Explain any YES answers and/ar any recotnmcndatians or any other comments.
Use drawings of facility to better explain situations. (use additional pages'as necessary)t.... Field COUP ❑Final Notes
a
%% �r%gr�fF /v�l�L �GrC�4?�Ofrl /n111�n�7 �2 = t�Fi,1� �rif�� cfGGS
p �.✓ �j�ioGTC/�"7�On% . /f70Z/1V7-
�V�-/1/I'1�/p,�} �7"ir,0
-7o,_M1-F Ale< 45724Q1-4,-,I-V4Y Ord dVAE 1�i1149
"'rS Cry. d a� 2
y
-01
Reviewer/Inspector Name 14
Reviewer/Inspector Signature: Date: p
05103101 v1 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32, Do the gush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes VNo
❑ Yes VNo
❑ Yes gNo
❑ Yes �Na
❑ YesN0
❑ Yes ❑ No
Additional Comments andlor,Drawin sr
eoMrle- a L NF .Q ,►
4A10
rot
how,
y�
05103101

Facility Number: ] — iA Date of Inspection Z p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes A No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )dNo
12. Crop type &rr- L d r, ii2o~4vee, Sall 4/�j + 1 (,lo,-r►,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes /",o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? oYes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes 0"No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑
Yes jZrNo
19. Does record keeping need improvement? (ie/ irrigation, Freeboard, waste analysis & soil sample reports) ❑ Yes 0No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes �No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 'ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes QNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 1QNO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 101No
. . yiQi��tQ�s:o� d fcpe��ie wire h • .......... •Yoh wit�....y........ • . .
1.'.' car:resntfideii& about: this visit.:.. • . • .... • ................. . .:::::.:: .
ux auaW.0 ua ux"a AaJ w "WILwa IPA§V waa DAMU"%!kW.
M r , I j .Srr V S Ile 'has 1 v r'GhG.(eA r l rn is c -f -o -fake 41,e s4 � 0 1-I 4 01 q hee A6
p')pe5 4kjAj dj'Se1�A"-)4 yp-�O r-to houses k?�✓✓ Oezn - Yale f)A0(,14 qo 41e.1d qVA da
4h ,`s Xq p,
kleed.S a we-l�ab�� a��e1 ole �cr ; viA b'o� c� p lejc.� asa. n0)�►,�(
-¢j7 c [�/ S e�p / n r l s �o be . w r I n q G Ga rv� rtc, -jam G��l er.�?•,'n �A'Z
, ►ijd-e1oe-AJr sharzld be ke�� OtCGUrG�r►'�� ��1?C Jtvgj�e pm" AoWd be
Wrv,pen 16 a.Cenn+ram rgzeandLt�;e1d���c-l4ce--
Reviewer/Inspector Name ' { '!
� . .,7
Reviewer/Inspector Signature: 94 Date: 26 %j ] 5100

Fagility Number: 31 — 2& Date of Inspection 71T40 1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Xyes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZJ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,ZNO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )ZJ'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 'Jallo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ YesIRNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/tcmporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawengs:
4e be -,,4 vol -r eJ (, cbo�l� -k w;dd le, h-ttf
n ets jo Lave -1�e x4q;ld be,^r,,odA iyYroved. ereed 4o be
S�or�r�G,,eir� t� 5��� J ZD02. �`� Pea'-$ � � 4 Wou d 46,k' IV,
cxGP ss ; VeC I a� - i.�e ¢� 6e+ +^'l.Vde, o o�L,ef or r s e -Feld
&Ad&- -Aa1J j'!o-k--d Above.) -��e Y'6Gpr'dS �t►�t4� �aG'1r� y a� ��a-�1� ke�-.
J
5/00

Dwision'of Water. Quality
E- ,
0 Division of Soil andi 4h
'Water Conservation '
tp Other Agency
. E
„N
Type of VisitCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )dRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
1 11 Date of Visit:
Facility Number
I
Permitted [Certified © Conditionally Certified © Registered
Farm Name: ............. ..... ................k.�s.. ..............................
OwnerName:........................................................................... ............
'rime:
Printed on: 7/21/2000
10 Not Oaerational O Below Threshold 1
Date Last Operated or Above Threshold: .......... ......
County:....... .. .. ...
Phone No:
FacilityContact: ...................................................................... ........Title:................................................................ Phone No:...................................................
MailingAddress:......................................................................................................................................................................................................... ..........................
Onsite Representative: � �—� ........ ��.............. ...... Integrator:........... w'trP,j
Certified Operator:......L�,..l.iti:................... ........... ....... �-............... Operator Certification Number:..........................................
Location'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude u • �� �«
Design Current Design Current Design Current
Swi�ae Capacity Po ulation Poultry . ' Ca aci Po ulation Cattle Capa'dty hilwation
Wean to Feeder ❑ Layer ❑ Dairy
der to Finish -7 z ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
arrow to Feeder I
❑Other
� Fir
131 arrow to Finish '
Total Design" Cei0kiti
Gilts .
oars Tow;SSLW
None 0 4 Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE3 Spray Field Area '
Holding':Ponds / Solid Traivi 10 No Liquid Waste Management System`
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [:]Lagoon ❑ Spray Field [-]Other
a. If discharge is observed, was the conveyance man-madc?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. II' discharge is observed, what is the estimated flow in galhni0
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: .......... ...............................
Freeboard (inches):
5100
❑ Spillway
Structure 4 Structure 5
❑ Yes )2ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ Yes �No
Structure 6
Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) J`
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes JN�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
11�o
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type �r 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes VfNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
T10
b) Does the facility need a wettable acre determination?
❑ Yes
gN0
c) This facility is pended for a wettable acre determination?
❑ Yes
U No
15. Does the receiving crop need improvement'?
AYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
zo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q3 ANo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
,RNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
Wo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
jk(No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
io
24.
Does facility require a follow-up visit by same agency?
❑ Yes
_PNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
$No
O•YiO1biti0ijs.oT ftficiel 6bg •►1�rb hofje(j• d. twirig �hjs.VjsIt; Yo" :w.i1l•reegiye qo: f1 thgr • • • "
cor'res�o deli& a 6a f this visit:
Comments (refer 'to question ft Explain any YES answers and/or any recommendations or any other comments i,
Use dr"v! igs of facility to better explain situations. {use additional pages as i eeessary)
Reviewer/Inspector Name y Q$��{ a v 3',. y
Reviewer/Inspector Signature: Date: — - 5/00

Facility Number: — % 7 Date of Inspection Qh Gd Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0
liquid level of lagoon or storage pond with no agitation? ��
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [(No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Jallo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JVNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �To
32. Do the flush tanks lack a submerged fill pipe ora' permanent/temporary cover? EkTes ❑ No
Additional Comments and/or Drawings:
LAC
ttiG741 wt
5100

E 1 t i nt I 1 { d
i
Dtvtsion of Soil and Water Conservation fQperateon Review "'! „
' G ,s . [3 Division of Soil and Water Conservation Compliance Inspection ]r
41?I�`1 ` ' DI"'i Of WateC ' Ualt COm lianee IIS CCt10A i E' > I ' r Ik�r € `E a i�! ;: € �. E ' € 1 ig j I� r�
Q tY P P I
Ot)ier Agency, Operation Review y r 1"I "i r l I i it
E, ,I �- " 1 t €,
t ,T
Routine OComplaint 0 Follow-ue of DWQ inspection 0 Follow-u of DSWC review 0 Other
Facility Number Date of Inspection J&I'
Time of Inspection. 1 7A hr. (hh:mm)
A—pe
rmiited Certified 0 Conditionally Certified ©Registered [] Not O erational Date Last Operated:Fam Name: ..... 1 . ..:......... ......... A19.tf..5..�. - 4j(,5.k .......... C.ounty.....�)e�.f!.... ........... ............
.....��.......
�7
Owner Name: ..',j.l'lYk............. L�.es� f' ............................ Phone No:...1..���...0.......................................
3�
Facility Contact: ....... S�...... .. Title: Phone No ...........................
Mailing Address: ..........................................
Onsite Representative. .............. .... �I. �i.&...........1.�t.
•.—s............................................. Integrator:......W-A!d .....1...'.A.1.1..5............................
Certified Operator:................................................................................................................ Operator Certification Number:.................... ......
Location of Farm:
........................... ...... ..... .. .........................................
Latitude 0=° =11 Longitude • r 46
Design Current Design Current Design Current
Ca acity Population Poultry l� Ca� a'cityPo` ulation'.' I E Cattle' Capacity Po ulation ,
❑ Wean to Feeder
Feeder to Finish
3L7 i-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer
❑ Dairy
❑ Non -Layer
❑Non -Dairy
❑ Other It,E'
is
Total Design Capacity
Total SSLW
f La ❑Subsurface Drains Present ❑ Lagoon Area C
Holdin' �Ponds p L1� , .
}Numbero goons-
g / Solid'Tra s ❑ No Liquid Waste Management System
llischart es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Water of the Statc? (If yes, notify DWQ)
c. Ii' discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (I1'yes, notify DWQ)
Spray Field Area
E +,
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1
Identifier:
Freeboard (inches): .......... ........................ .....
Structure 2 Structure 3 Structure 4
Structure 5
❑ Yes 5TNo
❑ Yes ONO
❑ Yes �No
❑ Yls (XNo
❑ Yes (KNo
❑ Yes %No
❑ Yes XNo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/9
❑ Yes -to
Continued on back

Facility Number: — 7 7 Date of Inspection -/
t7dor IsstleS
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to. discharge at/or below ❑ Yes ?(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes O(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) [)Yes )�CNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;LNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑YesVNo
itionaComments an" . ,or rawirigs:
AI
3/23/99

Facility Number-3 — 7 Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes MNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ANo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes INO
Waste rknolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11,
Is there evidence of over application? []Excessive Ponding ❑ PAN
❑ Yes
jJ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
5TNo
14.
a) Does the facility lack adequate acreage for land application'?
❑ Yes
l9No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
t�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
*o
Required Records &_Docum_ents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
0No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists; design, maps, etc.)
❑ Yes
$No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
,Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
t .No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
'
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
%No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
.❑ Yes
P(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
5(No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
NIOMW'n(iotis'or- &ficiencips •N-ygrp ito(ed. iit,•t'ttag tils;visit; . YoO yvifl-t<ee0iye jjfl futi ftr
;co rrespotidence. a)botit. this visit.
Comments,(refer to,�quest on #)-`Explam�any YES hnswers,andlor,any recommendations ortany;othericommentst,�=; I ,I°F �, r�,!iiryI
Use drawings of facili to better, explain situations (use idditionahpages as necessary) , , : ;jlri
q1�,✓. t o Ar, T3,-6+ i5 Gt rLw%f}I wAi4fy� o,.L p'�e_ (wh:&L Wilt h.e kere-
in h'. A4)_ -1.0 ? K,-e . T
4k� vv�t�( Wit Gotwi��-,�,�ts arL
co A44
ReviewerlInspector Namepq
Reviewer/Inspector Signature �� ifhn ' %•� ��+ rjA Date: - l _ J"F , f
D UJ Y (510) 3 5 5-,3 U0 _a)6�— G ZS 3/23/99

U Division of Soil and Water Conservation Other Agency ,
Q �WDivision of Water Quality
a:.
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection i
Facility Number
Time of Inspection OGO 24 hr. (hh:mm)
Registered 0 Certified © Applied for Permit A Permitted 10 Not Operational I Date Last Operated:
Farm Name :.......... lcr�,ls.....1�`��?.....r�!.r�................................ County:........... 1�.ti..
............... .............................................,..................
Owner Name: L"t. ht� j-- Phone No: Q 1 car S�
L..1..............................L..� Y........................
FacilityContact: ................................................._.....[................./...... Title :................Q................................................ Phone No:...................................................
Mailing Address:.. �...1..... ' ^1ti'3...4,...?'c Xti'r� S...!.. ....... KC......... W 3. 4...................
�.......
Onsite Representative:..G?!."_,.✓.................................................................................. Integrator:.... ...........................................
Certified Operator;............................................................................................................... Operator Certification Number:........ .................................
�42 io of arm:
�.
�... .�7.... .............,.......................................................................................................................................... V
Latitude • Q' =1
1 Longitude & 0 {i
,Design ;
Current A . �: v" Design Current .$
Destgn Current
e
�.
$wined w r 'Capacity ' Poultry ; Capacity Populatton; Cattle
Capacity Population
,Population
` ❑ Wean to Feeder
❑ Layer Dairy
❑ Dai
Feeder to Finish 'a
,x ID Non -Layer ❑Nan -Dairy
❑ Farrow to Wean
^v..
❑ Farrow to Feeder
❑Otherfy"
v
1
❑ Farrow to Finish
R
y s Tagil Design Capfacity.
❑ Gilts
s _
y yb
3..
❑ Soars
Z T W
„.. otal "SSL
�Ntiinber of L�agoans f Holdtng Ponds
❑Subsurface Drains Present
❑Lagoon Area
❑ Spray Field Area
r <
t
>
❑ No Liquid Waste Management System
km
WV .��
� '. .4„• rAI
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system! (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes X No
❑ Yes kNo
❑ Yes
gNo
❑ Yes
EkrNo
r4
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures La Dons oldie Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):........... 3-1.Q..................................................................................................................................:.......................................................
10. Is seepage observed from any of the structures?
❑ Yes
t%No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
14 No
12. Do any of the structures need maintenance/improvement?
1XYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WNW, or runoff entering waters f the State, notify DWQ)
15. Crop type ....V:�.qf....... cpt,t:14 Tay .............................. .....................................................
..............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
)ZfNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
10 No
18.
Does the receiving crop need improvement?
14Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
ONo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZNo
22.
Does record keeping need improvement?
"Yes
❑ No
For Certified or Permitted Facilities Onlv
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
0 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
JgNo
0-No.viulati6nsor deficiencies.were nated-during this.visit.• YodWill recei�e•no�furttier-.
. coeres'pOndeke about this;vigit:-
p'^"1
�V(I.Q 4604 ��a
4,� 1 ti /25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date;

0 Division of Soil and Water Conservation ❑ Other Agency �� 1
r:: ® Division of Water QualityAr
IQ Koutine O Complaint O Fc)llo,,%,-up of MV2 ins ection O Follow-up of I)SWC review O Other
Date of Inspection- iz 47
Fac►lity Numlaer G
Time of Inspection t3! bt7 24 hr. (hh:mm)
0 Registered M Certified 13 Applied for Permit 0 Permitted 10 Not O erational }Date Last Operated:
Farm Name: ............!..................!i!................... County:Ihl?..lilts..........:.......... .
Owner Name.........&A........................................................... Phone No:..���`t.�.�'.��.2�..........................................
Facility Contact: ......
11�4tot.........&o. r..................................... Title:...... a0.tsW ......................................... Phone No:....00)1.' 1. 17;1......
Mailing Address: .... M-1 ........ ...... C",wV-QG 5........................:..... ..... ...................................... ..Z.g.3.c,.s
Onsite Representative: ...... vVin.!?....... aps....................................................................... Integrator:.......&-i'..L�............................................................
Certified Operator;......... ........ &a-V................................................................ Operator Certification Number:....Zaaa3 .....................
Locution of Farm:
n►1{:...:: A ..... --.......:.... Pui l Tuna... C........Q,r:.....C: ..I�b.Q. ,.....urns ...I:�..:..�r, ........5�, (a• r+�"" A.....f'.t'...ai,...��...�Xm..:...........�h��.�...0t4:.1f1�r✓:...�5� e r.✓A.
tt
Lt.A...ors....s ..«. ......... it . .... . .. .. tl...
Latitude • =1 =11 Longitude =• ..1 ... 1 " ,
Design'Cierrent.
Designs Currents r h , Design Current
swift, V :
Capacity, Population
.
Poiiltr Ca acit ; P.o .ulattanf Cattle i `•
x Y �...o P Y p Capacity 1Papulatign
[] Layer ❑ Dairy
k `
, ❑ Non -Layer ° ❑ Non -Dairy
❑ Other X
6T0tal Design Capacity 3 b Z
W.M.
n '> �Total'SSLWtf r
ILE
N n�ber Lagoons 1 Hol6ding 3 i;n
' ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Geld Area
of
; 1
'; ❑ lio Liquid Waste Management System
❑ Wean to Feeder
eeder to Finish
Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
RNo
b. If discharge is observed, did it reach Surface. Water? (If yes, notify DWQ)
❑ Yes
� No
c. If discharge is observed, what is the estimated flow in gaVmin?
k)
-d. Does discharge bypass a lagoon systern? {If yes, notify DWQ)
❑ Yes
5 d No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
2LNO
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ISNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
®No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
� No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
.A No
7/zsi97
Continued on back

� a
Facility Number: -j
8. Are there lagoons or storage ponds on site which need to be property closed?
El Yes
�] No
Structures (Lagoons,[fold ine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
54No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:
Freeboard (ft):..............................................................
10. Is seepage observed from any of the structures?
❑ Yes
1KNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KNo
12. Do any of the structures need maintenance/improvement?
❑ Yes
U No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
[XYes
❑ No
Waste Aoulication
14, Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, ollr runoff entering waters of the State, notify DWQ) ` ._!
...... IiR.3'r,.................... ona��.... rA;,..........C.Ofn............. !!��I:�A.c,.!.................................................................................
15. Crop type �.�%..M S- � . y�..........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.vitalatio:ns•or deficiencies rvere•noted during this,visit.:You,will 'receive ni 6-ft rther .
. • correspondence Ah.00 this'.visit., .
Use drawin s of fictht �fo better�ex lain s�tuatipns use addfnr�tronal `a es as'necessa `�
13- Lig4 I"e.� wh"t!w SKbvly Oc, ST1rP►yt RJ1X +-
It,- So��pounS �U.a ' As_ccdJ ,,off{ bA
22, �n.I�C 3QFn`� • QV14VSt S r-61J kG v�JoAcd. (irr,' on mixt SIvt,13
ReviewerlInspector Name
❑ Yes
JK[ No
❑ Yes
No
❑ Yes
No
❑ Yes
Eff No
❑ Yes
f.No
R Yes
❑ No
❑ Yes EkNo
❑ Yes W No
❑ Yes DZ No
7/25/97
Reviewer/Inspector Signature: Date: