310100_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

4r
FaciLty. Nuittber pU 0 Division.af.Soil ani[ Water;C6nservahon:,.
0 Other.,;Agency m
r
e of Visit: Com ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
son 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:
Farm Name: J e,s-�i � hic-f� '1 �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: o 64*1 I e4,-
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
n
Design Currenf;z_ -dw esign"'�Cur
Swine CapacityetPle ury' . Capaeity
Wean to Finish Laver
Longitude:
Region:
w M
Brit "°° °` wDesign "Current
p MCattEeCapactty -pop;.
W
W to Feeder Non -La er
-7 7-79
eeder to Finish 2(7
Farrow to WeanCurrent
Farrow to Feeder
Dr. yPoult
Ca ac►ty
`: Po
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
Other
Turkeys
Turkey Poults
Other
Other
Beef Fee
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZfNo ❑ NA ❑ NE
Discharge originated at: ElStructure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes gNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? 1-11
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes FNo
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued
Page I of 3 21412015 Continued

Facility Number: - 112 = I Date of Inspection: �2 ^)►
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? r] Yes L
o NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6 S - ( �5 - 2r ZTn'i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d� I ft 7 2 el 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes IzNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesVNo ❑ 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 ONo ❑ 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): :5d
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
6/No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps [:]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 0 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 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: tab [Date of Inspection: - 7
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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes VN
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus lass assessments (PLAT) certification? ❑Yes❑ 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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
[—]Yes [-]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question&#) Explain any�YlES=answers and/ornany additionakrecommendat�ons or,",any of er commenis_ r
Use drawin s of facility tobetter; egplans�tuahonsfi(use�addihonal pagesas,nece'ssary,)
17
#3 8-r�-r�
2, �9
Reviewer/Inspector Name: Phone: ! -)5 C y Zdb
Reviewer/Inspector Signature: C� (,( 54 4"e Date: % z —25
Page 3 of 3 21412015

1"Sion of Water Resources
s
- © ®DivisionoftSoil-and Water Conservation
Type of Visit: —0-C-ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: &Uoutine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County: c46e/.-N Region:t,��
Farm Name: ��� y , % i ,i ,ZYh.-r ,� ��C�,,, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: p _L�til t� l Integrator: _A-2
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
` .. ]D"ign' ^Current
Design Current
Design C•urreat
• s .x.
y
CapacEtyop
vVet Poultry
Capacity r,op.
Cattle Capacity
t
Wean Finish
La er
Da Cow
Wean Feeder
Eto
]Non
-Layer
I Dairy Calf
Feeder to Finish
IDairy Heifer
7z-
D . , Foul, `p
Design Current
Ca :aci P,o ,
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
I Lavers
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
m Other .. �.. + _
Turke Poults
Other L
41
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 DW R)
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?
Page 1 of 3
❑ Yes LNo ❑ NA ❑ NE
❑ Yes [�fNo
❑ Yes P"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes 21No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
r
21412015 C"dnued

F/
/Facility Number: T3 J- j a 0 1 jDate of Inspection: 17_a= -1 1141
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 7 3
Spillway?:
Designed Freeboard (in):'
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes �10
[:]Yes VNo
❑ NA ❑ NE
DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Vj No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
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
VNo
❑ 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
O/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - O U Date of Ins ection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej"No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ,❑'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 121No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ;allo ❑ NA ❑ NE
[:]Yes Po ❑ NA ❑ NE
❑ Yes ID -go ❑ NA ❑ NE
❑ Yes .❑No ❑NA ❑NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes J:R'No ❑ NA ❑ NE
❑ Yes J2-1Clo ❑ NA ❑ NE
Reviewer/Inspector Signature: /4 Date: 7 f
Page 3 of 3 21412015

': ` �` -"` - ,. D1V1310n ©f Water Re50UrCe5 � � � �'` v • ��"
Facility Number QQ Division of Soil and,Water,,Conservatron�,
0.0therAgency'
Type of Visit: _101Campliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QlAoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L_1s:�J Departure Time: County:
Farm Name: YVX A= 1, 's Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Region:
Integrator:
T�-
Certification Number:
Certification Number:
Latitude: Longitude:
i-
.j
Design Current, Design C�irrent sign Co
urrey
Swine Capacity px.pop. 'Wet Poultry "`Capacity Pop Cattle E p ty. Pop: .
.,.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
kp' Farrow to Finish
Gilts
Boars
Layer
Non -La er
a
Design Current -
Drm `Poultr "Ca" aei 'Po
La ers
Pullets
w.
1 wac a
Other. Turkey Poults
Other1, 10ther
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 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?
Dairy Cow
Dairy Calf
Dairy Heifer
IDry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
2.
❑ Yes dam-' No ❑ NA ❑ NE
❑ Yes X—No ❑ NA ❑ NE
❑Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
d o
❑ NA
❑ NE
[:]Yes
[ No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

{ Facili Number: -InaDate of inspection:
IF
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C2^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: 1; J 9— 3
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 3 G f
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes XNO
❑ Yes 0No
0 NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 1,lo ❑ NA ❑ NE
maintenance or improvement? /�/
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need r ❑ Yes WNo ❑ 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?
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 JC]�Vo ❑ NA ❑ NE
❑ Yes ;2No ❑ NA ❑ NE
❑ Yes J2'No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Yes t2"'N'o DNA ❑ NE
[:]Yes ;�,No ❑ NA ❑ NE
❑ Yes L2-No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J:no
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?-- ❑ Yes '2�0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑'NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
2,) Did.th2 facility fail to calibrate waste application equipment as required by the permit? [-]Yes VNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 'La' -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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes P 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes P No ❑ NA ❑ NE
❑ Yes �No [DNA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes Fet No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes §No ❑ NA ❑ NE
VL
e 'a SCa^ a'r\
�s2
r
� f
I
Ova 19ai e Q roc, s ,
1 �
<<6�
LS �
)aodoh -.z
loik Qd,.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: W C 132K
Date:
2141f014

I
— - .Division of Water Quality
Facility Number - ® 0"Division of Soil and Water Conservation
O'Other Agency`
type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: VRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
rr. r
Date of Visit: Arrival Time: 5 Departure Time: /h County: �1r� Region:
Farm Name: - -- — Owner Email:
� Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator:�
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
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:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
TL
a er
Non -Layer
Non-L
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop-,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes .6 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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
Page 1 of 3 21412011 Continued

i
I.
M
Facility Number: S} - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes POS4o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Sta 3 Structure 4 Structure 5 Structure 6
Identifier: 1 -2 hi�>
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2L15r
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes �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 J/I No
[DNA
❑ 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 Jallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PVo
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require ❑ Yes E!rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
❑ NA
❑ NE
j[2"No
❑ 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 ;6 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I!I'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �ZNo ❑ 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?
Reuuired Records & Documents
❑ Yes 0 No ❑ NA D NE
❑ Yes ENo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box. T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes En No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 6 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [2fNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

k
11
'Facili
Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,fl No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes �2rNo
❑ 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 M-No
❑ NA [3NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes )�JNo
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes P] 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 P 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 [ffNo
❑ 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 [;3-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 Q No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes allo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E314o
❑ NA ❑ NE
Comments (refer to question #) Explain any.:YES naswers and/or any additional recomns mendatio,o%y other�cominents
.. �..,.-
Use dra+wyngs;of.factlityxto;better eaplam„sftuat,ans,(use addihonalEpagesrtasbnecessa
w s .
Reviewer/Inspector Name: 1���3 Phone:
Reviewer/Inspector Signature: � ��,� Date:
114
49
Page 3 of 3 21412014

r
f0 Division of Water Quality
Facility Number ©- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection, Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: VRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: " ,County:
Farm Name: L�hYs�t� I1",11/l Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Region:_
Onsite Representative: ^— Integrator:
Certified Operator: �1Aa Certification Number:
Back-up Operator: Certification Number:
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:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I ELa er I I :--::]
Non -Layer
lets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEX Cow
Non -Dairy
Beef Stocker
Beef Feeder
13eef Brood Cow
❑ Yes 1z No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ;2�No
❑ Yes 2rNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facitity Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 161.5
Observed Freeboard (in): a On��
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 Vj 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 WNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aonfication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KTNo [DNA ❑ 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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ff No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PD No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V�rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
4 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
7No
❑ 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 ZI No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes kf_No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
o ❑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
4 No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�TNo
❑ 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
ZI No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Pj 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?
eo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 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
Z 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:
j
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P? No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any"additional recommendations or any other comments.
UseArawings of facility to better explain situations (use additional pages as necessary).
/V! VO,n ---},�;w, slm�l )I b�,,�A/4ret or ] k
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��In� a
Date: ✓ 3_1
21412011

Division of Water Quality
.Facility Number 3 j - %� Division of Soil and War Conservation:
_ ;a
Other Agency
Type of Visit: qkCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 3 5f Arrival Time: ® Departure Time: )Q County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:{ 14,y/ �� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design- Current Design _-Current Design -Current,,-
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other_
Other
Layer
Non -La er
Design;.Current;
1]ry Pnultry C'aFiaehhi" Pnn.
Layers
Non -Layers
Pullets
El
—.Turkeys
Turkey Poults
Other
Discharizes 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?
Dairy Cow
Dairy Calf
DLia Heifer
Cow
—.Dry
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Faoili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: JM.S l i-s
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 0 NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes . No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �j
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes l 6 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 ❑ er
Evidence of Wind Drift ❑Application Outside of Approved Area
12. Crop Type(s): � . OLAC�MK__CZ W1J69:' C�3t —10AI J�
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.
Q WUP Q Checklists Q Design Q Maps ❑ Lease Agreements
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ YeskNo
No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
Q Waste Application 0 Weekly Freeboard 0 Waste Analysis Q Soil Analysis 0 Waste Trans rs
❑ Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
o
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Waraility Number: T, I - Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
❑ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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 reviewfinspection 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 -additionairecommendations or. any, other comments.
Use drawin s of facili to better ex plain situations g ty p (use additional=pagesas necessary).,
w.F}. _� NA LS I LS a
31 pia 9. a a.4� ay
11 jLjJjj ). 1 9. q
c,lalln 2.8 3:0 2.1
Rc�(S r7 t CmU,- a �� 1. S a mb�! ��F �� S
- c.�►�- ��To A��N � U rnrY
p p F 0-- G
ZN� �S
70 fn gK-C-' 0�c 01c-
k�,pFY7F cge'4'vE�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q'���3 ,e'7
Date: g
21412011

^� Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0,Routine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: '�''''`J Arrival Time: /dam Departure Time: County:
y
�
Farm Name: ' f I F IL(Q �} °t l )VYtt�CWV, /A Owner Email: Owner Name: �c�s7l N 1 V1(AV2i4!A Phone: of s c[� — L/-� _
Mailing Address: —! Va G td U S/4J1i �eQ.�/ 1-� [_gC (Z ]IS ., / [� nog
O
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: _, 4siu�
Certified Operator: � 71 fit/ ^/1/ m(,�QQ t-{
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:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
er Non -La
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle
Region:
995S-3-4
Design Current' ="
Capacity ''Pop'."
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes *o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes 4
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility.Number: 3 d - X0 jDate of Inspection: 57D5
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: ,, ivy _(_S1 cs
Spillway?:
Designed Freeboard (in): 9 1q. 5
Observed Freeboard (in): Lq ' `
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No [DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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): 6,AC',Amd3ECZ5 +-� a 1` COTTON
13. Soil Type(s):
U I L-L-C M (� FOLAC
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
��][
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�'No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
QWUP OChecklists ❑ Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste T2�No
sf rs ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection:
v
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 9No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes *No ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
(Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments I
Use drawings of facility to better explain situations (use additional pages as necessary).
C A C_lQ'a T /o'V Dec <9X)3 j D
w.A. Ls
Q 13111 I. l.9
I T ou.-T la . o tz Sys �► �uT w �6 Go (tp S
pR 12R S (--OC- Pu LC-L/ rc� i.�ct`�flE 3 -22 —� 1
Q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Division of•Water,Quality.
Facility. N. Umber �Qt j 0 Division of Soil and Water Conservation
0 OtherAgency `
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �5 Departure Time: � County: C/)V Region: (�
Farm Name:LANAI SAnonj FAQen Owner Email:
Owner Name: _ 91 C.KLk L & T70AI (j� Phone 1�
w9 n �XpT a� 5Q5
Mailing Address: 62;� E hs Q�tD62 C-6 _ YEely it uiue ,/1��
Physical Address:
Facility Contact: Title:
Onsite Representative: .]011NN L� l ECL
Certified Operator: W I C.la a m C. 'S�Arro)v
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
]�3l�
Back-up Certification Number:
Latitude: [= o = 4 Longitude: = ° ❑ 6
Design'.. Current Design_ Current :=Design �ChrrefiG
Swine Capacity. .Population, Wet Poultry Capacity 1'bpula.tion Cattle Capacity Populahon
10 Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
Other
❑ Other .
❑ La er
❑ Non -Layer
Dry Poultry.
Discharees & 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)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number"of Structures °'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
q
❑ Yes IkNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Faflity'Amber: —, Date of Inspection J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes X'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: D
Spillway?:
CC c
Designed Freeboard (in);
+�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
' 1
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �No ElNA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ 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/improvement?
11.
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 ] 0 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) 11"T 5?1 5Cl
13.
Soil type(s) At,—, jls�V i LL.E
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
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ NA ❑ NE
Comments (refer to.qurs a estion #) ,Explain :any YES answend/or any-recommatio endns or;any'otherconnments b
Use drawings.of facility to better explain situations. (useradditional pages as necessary)
��Gaa coo w S . Cz . )os 1 7o GAT t...w coe_+ p6aWT T771 /vc-w EZA-W&-s
AMANDA /VE6D: 70 QE A!O T t N 3o
uP rE wtJ.Pa sEtjb10 DwCQ LJJIN JDa�S
Fi X(oT mro , 51/VCE A1.4ecN ojp - K6 Et' It) 5 Er wI'V 10 ew y�
Reviewerl[nspector Name NO j}/�/ �° Phone:
9�a +SG ��a3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/2&04 Continued

X,
Facility Number: Date of Inspection io
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑"` Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists _ _ 0 Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Xyes ElNo ElNA [INE
❑ Waste A pl_� ica�n 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis [IWaste Transfers ❑ )AUal Certification
0 Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather .C+ode
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 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 ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes XNo ElNA ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes C(No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32: Did Reviewerfinspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes �`` No ❑ NA ❑ NE
Additions! Comments and/or Drawings:
51/C/j/0 P. b D. 5 9.1-
9VA00 .9.1 �9_1
�r/aS,f� 1.5 � •5 �.�
PING {L( 5 /VC-Cb TO 6E(A>DRr0-N
CA" geld I (W r_-.fnE orb-4 f
�DFfIVN5A
5 � r� ►�- ��.1 �l� y�nf�- Ac- � c��G�A i �.�
12128104

Facility iNj ber; 3i I tx�
r
Sion of Water Quality _.
. m
soon of Soil and. Water Conservatton
Type of Visit O,Coo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �0 Routine - 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l a Itv O°r Arrival Time: 3 Departure Time: County: lam. PL-:E4J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ? PrrV_X41t_. FJ S S C-LL
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
U Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 1 Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
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
El NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
WNE
❑ Yes
❑ No
❑ NA
[�NE
12128104 Continued

Facility Number: 31 Date of Inspection f �b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA Z/NNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA
d NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes
❑ No ❑ NA
ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA
[(NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
❑ No ❑ 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
ENE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA
[21/NE
maintenance/improvement?
PNE
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 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
❑ NA
l NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
PdNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
0 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
E
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ No
❑ NA
WNE
-�,:� �,. �i." F..�7�s.--..-
UComments,(refer toquestton#) Esplarn any Y,ES:answers.and/or any, recommendatrons,or�any3other comments
se drA aw s as.neeessa ,'
Name Reviewer/Ins ector
p Phone:
Reviewer/Inspector Signature: ap. Date:
7�/�R//IQ ('nsrrinuvd

w Facility Number: — Date of Inspection V o
Required Records & Documents f
19. Did the facility fail to have Certificate of Coverage & Permit readily available? iYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have 1 components of the CAWMP readily available? If yes, check [KYes ElNo ElNA ElNE
the appropriate box. [WUp ❑ Checklists ❑ Design El 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 ❑ Sol] alysis ElWaste Transfers
❑ Annual Certification
❑ Rainfall L/J Stocking ❑ Crop Yield El120 Minute Inspections L Monthly and V
Rain InspectionVWo
Weather
Code
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?
❑ Yeso
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LJ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ON. ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ErYes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 0No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes to ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ yes �rNo ❑ 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 o ❑ 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 dNo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
' r tive? El Yes O No ❑ NA ❑ NE
32. Did Reviewer/Inspector fail to discuss rviwxnspecti e e Ion with an on -site e re sen
p eto
33. Does facility require a follow-up visit by same agency? [3 Yes ❑ No ❑ NA ❑ NE
Nib ro cktC_C(L 1.taC_ i-t&LlrC
At SC-C-oroO
LAG--"
fog CRAC_ _X_W NAL.L,.
CAC_ ZtJ ?-X:C-LY 'i 0-M O
-J Ah/ (- ► 4.
tAg)"2.
2, rs+-E b to r4 ILAL
tse C, a vef3a-rF6 WUP
W--t'H NEW
OWQC12_
AWO S�w KXO,
:Zt.) t jFfc J 7/acel $Ta c.ic��J G- 1.1erYJ S,r+� r_fL� " R+�-1 X.*JSeFC-T-Z:c-+3,S
a(„� Off. DESSc. N�1T3vrJ n16� OS t�'k UP 0 A r<-
12128/04

1r 1� l�l uiilbeT'. �
4
k Division of,Water `Quality
Division of Sotl2and' WV.ater. Copse vatton
Other=8gency, v -*
Type of Visit 0 CComm Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: C� County: Q Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = d = « Longitude: = o E_-1 ,
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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 Co
Number of Structures: E .
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?
ti
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
yNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Ni tuber: Date of inspection
t-
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: L, �7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes CNo ❑ NA ❑ NE
❑ Yes r—f No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V I No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes E(No ❑ 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?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 3/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 o
[I NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes O/NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes �K
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments(refer eshon# lJxp naisy YES an wers�an�/or any recommendations or any other comments.
Use drawings of facility o better explain sttuahans�(use add4tiona1 pages,as pecessa
-z - #�s� xl" ice-Q'^ 11-V ..'^r. r.,
Na &o_ uEz" KE (.o o3 --,a_xbc.L)w*
.,wry r � c19Fc�
Ink, CAYn fAIc. ED f4 6(-- AT fn E—C-CWG- fi LOd &- lk�XT lid PAS 2- W94 ,k .
M s t/A/TZ , DE C , lib f uv1 rd Aq Uk Coi°C(-S 6T pu, a'kE Uf" J &T
L � L) d
Reviewer/Inspector Name 1�-/ L Phone: /D 7 el
Reviewer/inspector Signature: Date: /� D
Page 2 of 3 1
12128104 Continued

Facility hfumber. I— Date or Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? �Iycs
es ElNo ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps [3 Other
21.
Does record keeping need improvement? If es check the appropriate box below.
P g p Y
LI 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?
dyes
[I No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Lam! Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
,[Yes
d Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
62No ❑ 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
,.,
Vivo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,,��,�
ER 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?
❑ No [INA
NE
33. Does facility require a follow-up visit by same agency?
Yes
❑ No ❑ NA
❑ NE
Page 3 of 3 12128104

Fae�lltyNuiiiber 00 ;E
DWIS104i of Water`Qualtty
Division of Soil and;Waier`Conservation
Other Agency
Type of Visit
C mpliance Inspection
Operation Review Structure Evaluation
Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: %d 9 Arrival Time: 91D Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
✓�A>✓�u.
Onsite Representative: `
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: = o = g
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ 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
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:EJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE.
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
❑�No
El Yes
,VNo
El NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

h
Facility Number: 1 — Date of Inspection l3
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?
❑ Yes VNo
❑ Yes ❑ No
❑ NA ❑ NE
El NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: I C !2W CA&VW 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZZ 3 d
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) `
/lo
6. Are there structures on -site which are not properly addressed and/or managed ElYes E
❑ 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? eyes El No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes LJ No
El 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 LS No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 l0 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ NA
IQ No ❑ NA
No ❑ NA
No ❑ NA
No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
7,) LFa_ Ar NduIC z AF CAC>,"AJ LEAK /aT Nalj� AT o<.vowz IN 7.a 6At-c*N) •
Di wunm- Bum wa u-s". 9w F_-xCP , b6wmFuru 00 f l�r,✓Q B� END
di* 2oof. Kf"UT ' L At,a'Q1,1 ►h A9.k6X 1,✓ LA6-6ori ("AmrvV
Ntf,*s W&p CA ✓Wtxa L An�b c r� u ur
w
Reviewer/Inspector Name 7,0 kgllf _ Phone: ( qiA 7�1�0,0
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 ' ` Continued

Facility Number: Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No
o El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check El Yes ❑ NA ❑ NE
the appropirate box. ❑ W`Up ❑ Checklists ❑ Design
g [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O 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 dVNo
El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
�o
❑ NA
❑ NE
❑Yes
7No
❑NA
❑NE
ElYes
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Zo
❑ NA [I NE
El Yes ❑ NA El NE
❑ Yes
O/No ❑ NA
❑ NE
❑ Yes
1/J No ❑ NA
❑ NE
❑ Yes
X ElNA
[3NE
❑ Yes
No ❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number EiD_=12
W Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Co Hance 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: 0 Arrival Time: ® Departure Time: County: Ob n Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Owner Email -
Phone:
Title: Phone No:
Onsite Representative: c 14�TJ{jj�Yl/ °�il
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 1 Longitude: =° 0=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
r. I ❑ Non -La et
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
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
[I Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E]
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 FWo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 lvo
[]NA
❑ NE
❑ Yes
13-14
❑ NA
❑ NE
12128104 Continued

Facility Number: '31 Date of Inspection I a
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ 01-efw1✓ 1, tA &dP3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `7 L 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
El/No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
E),�o ❑ 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
B No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
[� No ElNA ❑ 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/o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
L Xo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
is ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[) o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PIN
❑ 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):
rs,) C All 9ttoxa
Reviewer/Inspector Name OAJAJ Phone: /d 3
Reviewer/Inspector Signature: Date: /f
12128104 Continued

Facility Number: — 0 Date of tnspection 1 ! D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? nlyes ❑ NN El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes f=J No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
dYNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ 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?
ElYes
[]"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UNo
❑ 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
E3No
❑ 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
dN.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
facility fail
31. Did the to notify the regional office of emergency situations as required by
❑ Yes
E N
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑Yes
VNo
[ld No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

�-Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- — — — 0 Other Agency
Type of Visit Itompliance 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: Arrival )Prqe: 00 1 Departure Time: County: T - Region:
Farm Name:
r
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ c ❑ 1 =it Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
I
❑ Wean to Feeder ` 10-Non-Layer-
❑ Feeder to Finish
❑ Farrow to Wean j
❑ Farrow to Feeder.
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
j
❑ Daia Calf
❑ Daia Heifer
i
❑ Dry Cow
i
❑ Non -Dairy
❑ Beef Stocker
ji
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: EJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
❑NA
El NE
12128104 Continued

Facility Number:
W smote Collection & Treatment
Date of Inspection
it J4. 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
Stture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4/
Jr
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 ❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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):
rr
Reviewer/Inspector Name r C v Phone: 7
ReviewerlInspector Signature: Date:
Page 2 of 3 12128104 Continued

x
�f Division of Water Quality
Faci ityNumber Division of Soil and Water Conservation s
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ElDenied Access
j
Date of Visit: �5 Arrival Time: 112� e rture Time: �� County: �L2W Region: !/ e;1
Farm Name: t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Tittle:
Onsite Representative: _ aCk � �LlTz4/"
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
___ 01�
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =1 Longitude: ❑ ° 0 , 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I F��]
❑ Non -La et
Other
❑ Other - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Dischar2es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
&-
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
ZONo (I NA ❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes
❑ NA
❑ NE
'P'No
❑ Yes�No
❑ NA
❑ NE
12128104
Continued

F
f L�
Facility Number: v— Date of inspection Idy I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tzNo ❑ 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: ie � h�3
Spillway?: _/yo /n 1yo
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
21 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
13 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
VNo
❑ 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
El No
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No
El NA ❑ NE
maintenance/improvement?
ILIs there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
/No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops dANAUrn those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
[__1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
] Yes
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'ANo
jNo
❑ NA
❑ NE
t Sr,A'y� �,Q,9�f! �.✓ �aar�� `�/ �r� IU�G,OS �o �� Ff��o�i�'l3� �v,��1T Ca
Reviewer/InspectorName Phone: O- _3;iQ9 .
Reviewer/Inspector Signature: Date:
12/28/04 Continued

r
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? /Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropirate box. ElWUP ❑ Checklists ElDesign El 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 TransfersoAnnual 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 r No
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J No
❑ NA ❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0 No
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes FZ(No
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA XNE
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes XNo
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes V(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.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/ETNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�f
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes L�J No
JdNo
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
/Additional Comments and/or Drawings:
�9) /i/ Co j! �4, zVA; cow s G.,i� ("' e P,e ��m4
f�specTzno4 Ar Ae,�_c.Z-ry '` 3/-I q-6.
(d-7%zO 7V
'AA� �oA5'r__OA s F"10-
12128104

.� ti vtst ti of 50� and Water Co on � � ��-�- ;a m
Type of Visit 'Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit .0 Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number I
Date of Visit:
)dPermitted ertified ©_ !Conditionally Cued 13 Registered
Farm Name:: LL&*3 � "'" � ►4
Owner Name:
Time:
Not
Date Last Operated or Above Threshold: ..... .... ..............
County: ...
, _ W .... ............ ......
Phone No: ..............
Mailing Address :................._...................... ......_._. ..._.
Facility Contact: Title: Phone No:
Onsite Representative: T!r.._..........._._.................. ...... Integrator:
Certified Operator:.. ................... ................. .........� ..._......_.—_------ ..._._ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 46 Longitude • 1 it
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 0 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 ❑ Now
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ ............ ...... ............. .. __ ......... _......................................
Freeboard (inches): /L'L
12112103 Continued

Facility Number: () Date of Inspection 151
15. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes "Li N
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 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 9No
8. Does any part of the waste management system other than waste structures require maintenancermpravement? ❑Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ZNo
I I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type CS w C v Gu em Qki(S o CC o • fAMod d ATj SG
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 o
b) Does the facility need a wettable acre determination? ❑ Yes o
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes UNo
16. Is there a lack of adequate waste application equipment? ❑ Yes
Odor ];sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑Yes
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.
-CO(irefer tt► queslxor�_#) Eipiain nay YFS answers and/or airy i ecnmmeadations or any other comments. �.^.
'Use dr�awxngs_of fac�ty t[► better e�tpiauf"s7tuati0i©s. (USe 8d�l�ona� p$g"eS� neLCS.SSI�)s w�•�-;�.; �6.~.�:�^
veld Copy ❑Final Notes � -
Pic W w0e LXS'= 01 V_P� Gcors +wo 014MS 5-'-VT ACAZPE &E W FuLt,s 5-157 D�
,,,joT MATCH LEASE AG1j66r,1 Yr j7LEASE CLAlL�F'?
a[) & C ?eaVA= wj VCO"S.
23�) v wp STe At�A SSS -N C VOt }��,tu`P�.l� F+l6NZS
+
Cd CAc�BRA i� `
'�.5 N SW DBE SEA ANC
Reviewer/Inspector Name Et 64R9
ReviewerAkspector Signature: A&& Date: ? D
12112103 1 Continued

Facility Number: g j - 1 0Q Date of Inspection
%0
Reuuired Records & DocumenLS
8/Yes
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ No
22. 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
23. Does record keeping need improvement? If s, check the appropriate box below.
QYes0
❑ No
❑ 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
[j N
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
2rNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Co-
(ie/ discharge, freeboard problems, over application)
❑ Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ENO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35) Yes 7NI
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9 yNo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Y ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Yes ❑ No
Erstocking Form Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

of Visit 9) Compliance Inspection O Operation review O Lagoon Evaluation
Re.ison for Visit Routine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: B Z Time:
_...4 O Not Operational O Below Threshold
E3 Permitted M Cc ified E3 Conditionally Certified E3 Registered Date Last Opera d or
Above reshold:
Farm Name:f�G'l�. .......... .,. ., (�!._s.�f.T7�r� County: 11P? - ._.... ....
- -- •-•---.................
Owner Name:.............................................................._............... . Phone No:
Maffina Address:
FacilityContact: ..................... ..................... Title: ..... ..... ...... ........................................ ... bone No:...................................................
Onsite Representative. Integrator:.1�..............................................
_.............I�...................IT..._.............. _. .
Certified Operator: ...... .................. . ............. . .... ... . ......................... ........ .. .. Operator Certification Number:
Location of Farm:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: [3Lagoon ElSpray Field [IOther /1
a. If discharge is observed, was.the conveyance man-made? El Yes [l No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [l 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? YesNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Yes I No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Q Spillway Yes No
Structure 1 Structure 2 SwAture 3 Structure 4 Structure 5 Structure b
Identifier: e,3._................................. ...... .......... .......................... .... ._.................. I ....... ..
Freeboard (inches):.•••..... ........ ........ ��.........................�J ...

eiist�'Number. d Date of Inspection
5. Are there any immediate threats to the integiin of art_ • of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
5. Are there structures on -site which are not properh. addressed and/or, managed through a waste management or
closure plan?
(If any of questions 4-0 was answered yes, and the ciliation poses an
immediate public health or environmental threat, noti i• DWQ)
7. Do any of the structures need mainte=m/improvement?
S. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimpr6vement?
11. is there eviden of over application? ❑ Ex ive Ponding PAN ❑ Hy aulic Overload
12. Crop type _z R - n>sR�! 9 l _ l S /tfl<T i,01-70�
13. Do the receiving crops differ with those designated in the Ceftif ed Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre dete�on?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Pemtit readily available?
18. Does the facility fail to have all camiponents of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (W irrigation, freeboard, waste analysis & soil sample reports)
20. Is facaynot in compliance with any applicable setback critena in effect at the time of design?
21. Did thefaciilityfail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer&ispector fail to discuss reviewfmspwtion with on -site representative?
24. Does facility require afollow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AW1vT? .
D Yes INO
D Yes /No
/Aes —0 No
Yes 4No
Yes /fNo
Yes XNO
D Yes D No
D Yes (Z[No
El Yes No
El Yes � No
0 Yes D No
D Yes o
D Yes No
D Yes /No
D Yes No
❑ Yes l( No
D Yes �Vdl
o
DYes o
Dyes � Na
D Yes No
D Yes No
.D Yes .rNo
IE3 No violationsor.deficiencies-were noted during.this visit. You -will receive no further correspondence.about#his :visit. '

Facility Number: — 1190 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?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes o
ElYes ;No
❑ Yes FNo
❑ Yes e2140
❑ Yes No
❑ Yes ❑ No
-,4emoLIE t,�A-s,4 1�� GPrG.aoI� LI �zP� �ASfze
Og
-iQ�14CND b c L z,
- A9P Ow am 6C'OC6- Aw e6A-CGo
�rr
��Rla cF�C]5160 tCF�,O ClRr.
05103101

Devesian of Water Quality µ t -
O.:DiiviMoin of Soil and -Water Conservation y
Other Agency
0
Type of Visit X5
ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ij(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Number
Permitted [3 Certified ❑ Conditionally Certified [3Registered
Farm Name: ..............................................
Owner Name ................. ..........
Facility Contact: .....
Title:
Mailing Address:...................................................... .
Onsite Representative: ,�� '....�Q................................................
Certified Operator:
Location "of Farm:
'Time: 11410o Printed on: 7/21/2000
0 Not O erational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
`r
County: •-_......N ....................................................
Phone No:
Phone No:
----------------- - ----- --------------•---.----._...---........._..................... ..........................
Integrator: .-he`s
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �i •� Longitude 0' 4 44
Design Current
Design Current Design
Carreut
Swine Capacity Pa wation
Poultry Ca' aci Po ulation Cattle.. Ca
ace . Po. elation
- Wean to Feeder
❑Layer ❑ Dairy
Feeder to Finish a
❑ Non -Layer 1 ❑ Non-Dairyy
Farrow to Wean
Farrow to Feeder
❑Other
a r. Farrow to Finish
Total Design Capacity
Gilts
Boars
Total-.. W .
x'
]1Ie1
Subsurface Drains Present Lag -on Area
❑ Spray Field Area
Holding Ponds l So6d Teaps
; :
❑ No Liquid Waste Management System
i
z,.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obscrved, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State'? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (1f 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
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Wo
❑ Yes kNo
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Flo
Structure I1 Struc re Structure 3 Structure 4 Structure 5 Structure 6 �\
Identifier: ►.�51 ..
Freeboard (inches): 30 33 -mil
5/00 Continued on back

F2,_ility i`Jumber:31 — 00 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0jrNo
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
XYes
❑ No
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11. Is there evidence of over application? ❑ Excessive Ponding PAN Hydraulic Overload
❑ Yes
O(No
1❑ (❑
12. Crop type �� ►'+-�� 1.J4 �SG� i Ct� _ CC—,`�Q3 be_ c_�o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)7
MYes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
kNo
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
jjTNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
,Q 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
o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
UNo
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
A No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Onvo
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
INo
24. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
)<No
. . i�0 VI0���1QI)IS.Q. (��1F1Clt?EiCi££S 1?t'�C..... cart.. ih. .V ....o. . . . . t'. . . t. #'..... .
curies denke: about: thi visit. :.. ................ .............. .... ...:. • .
Comments (refer to; questron #) _Explain any YES answers and/or any recommendations or any other comments` `ter
4)
��. �.
T >
Reviewer/Inspector Name s �' x•
Reviewer/Inspector Signature: �� �� �^ Date: 4(�^G 5/00

peiiity,Number: 3 — Date of Inspection �= =� Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes^o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
MNo
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
WNo
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
;�(No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
/01 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
[rlo
Ndditional Comments:and/orDrawings:
J
5100

"`�' � � �� °�"- Q D�vts�on of Soil and Water:Conservat=on "Operation Rer�ew = =� '�^t �-t �.�s��n
'Division of-Soff and Water Conserva on-;Comgiiance Lispection "° 1
2D�vis�on of Water Quality .ComplVanee Inspection � .� �- ,� �-� - ���
:-
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number p Date of Inspection rl - -
Time of Inspection F�`2 24 hr. (hh:mm)
6Permitted 13 Certified [3 Conditionally Certified © Registered 10 Not Operational I Date Last Operated:
Farm Name: �.. jj.��.. �. �% rt�vL...... County:.............leti..1�11.,......................:.......
........IS. -lh'���................ f 1 .r%.......�� _7V1... t
OwnerName .......... .1r�-.... ............................... Phone No:.......................................................................................
...... ...................
Facility Contact: .... :.1. 1 . .. ....... ...Title:.......O N.......................... .. Phone No: ...................................................
MailingAddress: ...................................I...........,.........................................I........................ ................................................................................... ...
.........................
Onsite Representative:.._.,.. 1.J(�... q-14�.... Integrator �1......................................... ...............
Certified Operator: ......................................... .......:........................................... I—,.............. Operator Certification Number:..........................................
Location of Farm:
Latitude • 4 " Longitude • 6 69
Design':= ;Currenf:
Swine Capacity Population
❑ Wean to Feeder
eeder to Finish
fie?
3 L 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design -,Current' Design _ `::Current
Poultry Ca icily. Po'ulatiorr Cattle Ca aci -Po ulafiou
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design, Capacity:
Tatat SSLW- -.
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoan Area ❑ Spray Field Area
Holding Ponds/ Solid Traps , ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes igNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P!�No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ONO
c. If discharge is observed, what is the estimated flow in gallmin? ^A
d. Does discharge bypass a lagoon system'? (II' ycs, notify DWQ) ❑ Yes JETNNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Pi!(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �&o
Structure I! Structure 2, Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........
3a.,
. / ...........................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? {del trees, severe erosion, ❑ Yes [ No
seepage, etc.) ``
3123/99 Continued on back

T
'1l
Facility Number: Date of Inspection D
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
{If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes J21(:�Lo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes D(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
BNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
Wo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
-560
12.
Crap type
13.
Do the receiving crops differ -with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ YesJZO
c) This facility is pended for a wettable acre determination?
❑ Yes
AV40
15.
Does the receiving crop need improvement?
❑ Yes
[(No
/M`
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
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
KNa
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
f;(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Wo
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
JKNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
fi�qo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
0
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ANo
.. Vo violations or eficien... were noted c`i .. f.. . . s . ...will >. . . . .Rio. #'..
cories• orideirxce: about: thiis :visit: .......:....... .:..:... • . .
Comments (refer.to ggestion'#): �Explain'any'YE5 answers and/or any: recommenda_hons or any other comments:
Use drawings of facihty.to better:,explain situations (use:addihonal pages as aecessaiy)
Ct,4z,C,_4-
V4 ��HA aW�
Reviewer/Inspector Name r
Reviewer/Inspector Signature;/' y' Date: 7

I Facility Number: 7� — I)ate of Inspection 7
Odor Issuesr
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ko
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
2$. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes. 5�(No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes UNo
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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes A�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Wo
A Kona ,Comments and/or, ravings:
cx Cs1/L` S 254 1 ? 1��'v�-2 A -VP -z C14
L6
S lea
�— 5
0�-
5
ASS �n
� l .� w� V-Q C �J l S i G
Od 4 W
qV
3/23/99

1 . 11�
e. ... Division of Soil and Water Conservation - Operation.Review.
'[]_Division of Soil and.Water'Conseryation `Compliance Inspection
�Division of Water Quality Compliance 'Inspec4on
Othr r Agency.. Opetatron-Aevrew -" ,
Routine O Cam taint Q Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection f b
Time of Inspection tp � � 24 hr. (hh:mm)
Permitted �Certifed Conditionally Certi ed [] Registered 0 Not Operational Date Last Operated:
Farm Name: Q `�.+r . _..�j�_.. -.yi ..... :,]. .D........................................ ......... County: ......
........... P.4.p.'.^.. _................ .......................
Owner Name:................................................................................... Phone No:...............
FacilityContact: ........................... ................................................... Title:................................_........_...................... Phone No: ...................................................
MailingAddress: ................................................................................... ......
Onsite Representative; P uG.J...ahr-to.... (ery'44.......s �t.T.T"4...................... Integrator:.....GA0. D.1. L....s......................................
Certified Operator:,,... . Operator Certification Number :.................... ........................................................................ ......................
Location of Farm:
................................................................................'--'.........._...._.............................................._........................................................__.._.....'__......._.........._............................_. T
Latitude 0 ` 0 « Longitude '=
Design Current_ Design" Curretit Design Current.
Swine _ Ca acit Population Po At
_ y rY :Capacity -Population Cattle Capacity Population
Wean to Feeder I ❑ Layer ❑ Dairy
®'Feeder to Finish Z 6 a ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑ Gilts
Boars `- Total'.SSLW
Number of Lagoons: I� ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
HoldrngNPonds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4
Identifier: ,t
Freeboard (inches): ...........A.Z ................. .......... ........................... ..............
Structure 5
5. Are there any immediate threats"to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes 0"No
❑ Yes 0No
❑ Yes 00
❑ Yes PIKo
❑ Yes Ji No
❑ Yes j2fNo
❑ Yes �10
Structure 6
...................................
❑ Yes 'PTNo
Continued on back

Facility Number: 3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
B t6
❑ Yes XNO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: o yigiaiigris:or deficiencies -were noted during this'visit. - Yoix will-Teceiye tno further
.. cor'respondence aN ' f tizis visit. . .... . .... . ... . ........ . ..... .... . .
❑ Yes X,No
❑ Yes XNo
❑ Yes RNo
❑ Yes o
❑ Yes � No
❑ Yes ONo
❑ Yes VNo
s No
Yes �No
❑ Yes No
❑ Yes WNo
❑ Yes ,2�No
❑ Yes [2'No
❑ Yes 2'No
❑ Yes ZNo
❑ Yes �No
❑ Yes ZfNo
❑ Yes j(No
[:]Yes �1?qo
❑ Yes V(No
Comments (refer_to question #) Explain any IzES answers anid/or any recommendations or any other comments
Use.drawings of facihty.:to;better explain situations (use` additional_pages"as necessary) a �.,
F
/39 I +fit D i T-,-Ac : 9-t; r- e&IC-c-u D4e, ►ov-C rr XS C-
6 ,.(cry Lrwa ?Rota'JC_ER- ��Qa ram- �.�-t,.}r�Y ;u c,o"ja,4
I L- IR0 Trot 393 -3?t% "
Reviewer/Inspector Name `
Reviewer/Inspector Signature:
PT -
Date:
3123/99

Facility Number: — 00 Datc of luspection a 1^6
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below P"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 ;2'No
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
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 ;2N0
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 PAO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes INo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Xyes ❑ No
AdditionaL Comments and/or, Drawm u
r
'F,fL 2rkC 4C-4 �5 (JQ Vt 3 r_--5 .f n 'z- W-
3/23/99

Z..... er ,,
# ... .�; ,_•.:... ��z'�`
13 Division of Soil and Water Conservation
[3 Other Agency
Division of Water Quality
-n... >.<-,�:��-
Routine 0 Complaint 0 Follow-uR of DW ins cation 0 Follow-up of DSWC review 0 Other
Date of Inspection a q�
Facility Number o° Time of Inspection Z=GD 24 hr. (hh:mm)
0 Registered 0 Certified © Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated:
Farm Name:......... . r.Iry ............................. .... County:..... ���iul ..................
Owner Name: ............................. z ................ ILA............................ I................. Phone No: ....MA.Ll(a'.SSf.`.1.......Z�.4: �.R.�..............
Facility Contact:
Title:
Mailing Address:..... M.........
....
Onsite Representative: ............... �.�...�.I jDY.....................
Certified Operator :.......... tJIL.11-IA.fft ...L--............ l...
Location of Farm:
.............................................. Phone No:....................................
....... Integrator:.............C'my' f..................................................
..... Operator Certification Number, ... 123.-1Z .......................
...........ar....... ' .¢.....o .......Sly..... ..,..�: +nsla�....taw'...... a........ °�03 .i1.i:..................................................................I.-----
1f .....
.................. ... .... .... ....... .---......------.----
Latitude =, =° ® 46 Longitude 1 ' ©' ®"
Design . Current Design = aCurrent ° Design ='Current'
g
Capacity Population„, ;Poultry .. :.Capacity. Population ,. Cattle � CapacityTPopulation,'
❑Wean to Feeder
❑ Layer
x
❑Dairy
EA Feeder to Finish
q Z b6
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder
❑ Other ti� ,l
❑Farrow to Finish
Total Design Opacity lry(�Q
[] Gilts
, Total SSLW �75 r60
❑ Boars
Nuinl►er of La oohs ! Holding Pitnds 3
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
"
erLJ
❑ No Liquid Waste Management System
,
�r:
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
�j 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
[ No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
NIA
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5_
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
5.
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
1p No
7/25/97

Facilit umber:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LagoonsXolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes PNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .. .................. 5 ...............
Freeboard (ft):......?�.,.�..........................3;0 3.G
10. Is seepage observed from any of the structures? ❑ Yes 0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes [1 No
12. Do any of the structures need maintenancdimprovement? IM Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes CM No.
Waste ARplication
14. Is there physical evidence of over application? ❑ Yes [A No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Y.i.k.j04
..............: ..!..vC4:.....if:..Sall !.......--- tas�.1C±4
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
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.vioIationssor' deficiencie's.were noted -during this:Asit:• You.'-A4[I rece'i've:no-furtlier
::-corresp�nde�ceahou��fhis:visit.•: ,'.�::�:�:�: .�;.:: .�; :�....:.•-;� ..;._ ..,. .
❑ Yes ® No
❑ Yes %No
❑ Yes R No
❑ Yes ® No
❑ Yes q No
❑ Yes CA No
Yes ❑ No
❑ Yes No
❑ Yes [P No
❑ Yes ® No
Iz. eyttaor, aft" oh oukc - d\Ve- !/-lt or o4l `N. e- I` ,s SW3 b, -iLe A r"d. �=' ,0, �
''6-N -=- e,- I �w�- b i v - car- It o P . I t_a ,, 4 � 5 i�eyyc i�d 1aa k i [ l t� a rt�G ee� • g-,.t i w+ �e�� c�v� "a
�vWtt 2 Iag08nS SInvJt O !�¢ wlhwG�f�.ccl. th7C 1XCIA Of, �0.�03,. *3 411A l V_ 41W,
tz- 11 �°`'►. (���ts sl id bjj '`iCo1i 2� a�J�Y� �y t». i'tcevti l �.4+�aE[ ro�;11 ;5 'IaNJ�Ce
i,. NdJ ,T 46Gt ;. 11, do r41 �or 6*-Mac,- � S�r�ir�` � �svrr►m.cr, rv�uda l�ei1�
ion l?,ri �IV, S tielfl l i_ k,_ spy- lA r 151 ar W ce , YXOOA t�v�w�q� io te. IRf- iw`
dc_5l44 ]W
Sapl 4-rs� \14-CtJ%s 6-_1,_ ,r ►hc 4- Caepu- LLO?k. iK sp►� FAck. 'C3e lud's -Iwvij 6e- C1
01
+�'ovg616. Cun�s..cli�,e {✓�C�"-i' N co-v" ayst54- it sst�L- rt,iv�ltts SOS t'en. 7125/97
H_
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

MO DSWC Animal Feedlot Operation Review ' a
DWQ Animal Feedlot Operation Site Inspection
[®_Routine 0 Complaint 0 Follow-up of MVQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3
Time of Inspection ) + Z 2.4 hr. (hh:mm)
17 Registered 19 Certified E3 Applied for Permit E3 Permitted JE3 Not Operational I Date Last Operated: ..........................
n c �fI
farm Name. ......r� �! .... ... - nn......aV LQF\.... er frh....................................... C'ounty:.........tA..................................... .......................
Owner Name: ............. 6L . sv. ........................................................... Phone No:...
Facility Contact:........ n.. ... .. ... Tit le: ....... ar 2W. ..............:...... . Phone No: • `l...........
Mailing Address �,� T .....
Onsite Representative:... !`......-Su........................................................... Integrator :...... L.atYti� S.............----................
Certified Operator:............................................................................................................... Operator Certification Number:...........1.�..3..Z....
Location of Farm:
...IrA .......r,,o.r. ........... ....... u� .1� .►... ..... ]aer.. rn..... m....r.� c� . s....5.% .f53°1..........0 r�r►.... .....
.:1..-.+ :.�...rl � .F..-.o.-:...a... Crate..............a�n.......r� .........................................................
Latitude i 4� Longitude • 4
I
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
LfZW
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current- .'
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I I0 Non -Dairy
❑ Other
Total Design Capacity.
Total SSLW
Number of Lagoons / Holding Ponds Fff Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
.lq No
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 Surface Water? (If yes, notify DWQ)
❑ Yes
[A No
c. If discharge is observed, what is the estimated flow in ,allmin?
IJ
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
CA No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
M] 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
M No
7125I97
Continued
on back

Facility Number: _g—
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures (Lagoons,fiolding Ponds, Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 11 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........... jk-j ................. ............ .. Z..................... :�..3...................... ........................
Freeboard(ft):...........3.3.. 31........................3:. ........................... ..•.......•......................................................I...........................
10. Is seepage observed from any of the structures? ❑ Yes V�No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered ves, 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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ......... a45. ..---...6 &Jpl c
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
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`?
0 No.violatians or deftciencies.rvere noted -during this'visit.- Yo'Umill re'cei:ve-n' o ftirther
correspondence about this:visit'.
[,Yes ❑ No
IN Yes ❑ No
❑ Yes to No
❑ Yes 0 No
❑ Yes fg:No
❑ Yes No
❑ Yes No
❑ Yes $[No
(&Yes ❑ No
❑ Yes l5 No
® Yes ❑ No
❑ Yes R No
❑ Yes ® No
❑ Yes lR No
Corr xtents (refer to question #) Explain any YES answers and/or arty recommendations or any other Comments. 4 a
Use d-awrags '..acthty to''better explain srtuatians {use additional gages as necessary) �>
a.
ti-�1 �-- E�Siot•� p�•ec�s or. � jpyy.r � oc�v— f�LS 0� `�a�cArt � � t inrta.r �� o� �a9oo►^ #Z a,v+J �
��
a ar• aE( �rce ( oohs �r L4 or, a[t �4ur e is ins i6vlj be koC4r��
ae. ej wtAs " ilttj �0 ktseedeJ. Uro� 4 v&,;. o4ai, m ycl, ors -s ( s
4 Z �F- #3s oW % �` �W c"J rise ede d. f
zz_ s , cots (�ovlc� +�e. KcQf � by "n nvmhevr 'I
V Sl Gojt1 be.. ;n WOt .Jf t�I� nr ��an- �,�sec��b&r c�r.�taI <f- �n tii� JisrJ
ff,, ch eu(�sl� aJ[tl b� irr 04\n- 7/25/97
Reviewer/Ins ector Name ' - £�
p xt. { W#
Reviewer/Inspector Signature: IL_— _ �j �, Date: q ho m 7

1 Site Requires Immediate Attention:
Facility No. 1 1�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner: Rk
Mailing dress: R+ cw p LA. f G 1`I . C,
J
County:
Integrator: Phone:
On Site Representative: _VrZ n
n Phone: �!F/( a26 — l m
Physical Address/Location: /.C]a�"� < f P � G�cSI ` �3�' I�� f�_ Xy" Sry r 'o
Type of Operation: Swine f Poultry Cattle
Design Capacity: ZIL tj Number of Animals on Site: 1,2-
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 !j' Longitude: �7 ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)e or No Actual Freeboard: T_FE_ Inches
Was any seepage observed from the lagoon(s)? Yes oi�g Was any erosion observed? es r No
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS 154nimum setback criteria?. 200 Feet from Dwellings or No "
100 Feet from Wells? 6 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or4
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oN 7
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with. cover crop)? Yes or No
Inspector Name
G
Signature
cc: Facility Assessment Unit
11
Use Attachments if Needed.