310182_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quail
W)

c
(Type of Visit: Q-Comph a Inspection (J Operation Review O Structure Evaluation p Technical Assistance I
Reason for Visit, Outine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: 11.0 Arrival Time: ® Departure Time: 0 7 n County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,/ Title:/. Phone:
Onsite Representative: - l 1 r1 n. y �'cµ / Integrator:
Certified Operator: Certification Number: 2 5 s
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity op.
W o Finish
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
can to Feeder
rn
NN on-- La er i
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Desi Current
Dr. P,oultr Ca aei P,o P.
Layers I
Gilts
Non -Layers
Boars
Pullers
lBeefBroodCow
Other
El Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N NA ❑NE
❑ Yes [jN ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412015 Condnued

Facili Number: - Date of inspection: <7
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: Z_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes eN07❑ 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 �❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ NA
gNo
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑ 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 EfNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ONo ❑ 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?
❑ Yp-- No ❑ NA
❑ NE
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.
E3Yes ❑ No
❑ Yes No
❑ Yes LJ
❑ Yes WNNo
Yes ❑ No NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement? If yes, check appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 21412015 Continued

Facili (lumber: Date of Inspection: p & ( 7 1_
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 ❑ No lFA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA
❑ Yes 0 No ❑ NA
❑ Yes P_&o ED NA
❑ Yes No ❑ NA
❑ Yes [ AI ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
/cuf ,raSS.
Sc�pP sue' 1�c� (
�^
9 /0 2 / G y
jq C,7 /pc�.t , < Io..c,,/rC F1fi.t. D�—R sow I. �if I� in /fe-,,�cls
147.
2 1, �� a• ale
2 r-5 fit'•' CC"—f�^Cec( {��e� I.
1 of ,./P�/'eq S irp9 � o�n�s -� ��,.,✓'A �-•�hut� �
1 L'A �1 y•/ 1'�GQS L{,i'r1 G� i/cCO rc S
�Gti.f?�' 9� f��/`C• � O�-e 4�7� t^✓s /''l On (4 090/� /PL I�S.
/"'-ri--91tiCer 46,I'Ao s�.dti�
Reviewer/Inspector Name: p ✓ r L Po -.e % Phone: 1 I D _/TG 7.30 y
Reviewer/Inspector Signature: t��i( Date:
Page 3 of 21412015 .

13
Il ype of Visit: Jel Corg9lfance Inspection U Operation Review () Structure Evaluation (.)Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: G46Arrival Time: v r Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
w
Phone:
Title: Phone:
Integrator:
Certification Number: 2S s Q
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
W an to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
can to Feeder
•z 7 o
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Curren[
Dry Pdoultr, • C•_a aci P,o P.
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
TurkeyPoults
Other
Beef Brood Cow
Other.
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 DW R)
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 ❑ ❑ NA ❑ NE
❑ Yes ❑ NA El NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: Date of Inspection: 6
Waste Collection & Treatment �-
4. Isstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 "o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 Y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ 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 Ej No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rn 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 Z 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 �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No - NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 N ❑ 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?
If
❑ Ye -
jjlYes
N/o ❑ NA
NA
❑ NE
NE
20. Does the facility fail to have all components of the CAWMP readily available? yes, check
the appropriate b
"o ❑
❑
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 l" Rainfall Inspections Pludge 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 ❑ o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appr 'ate box(es) below.
ailure tc complete annual sludge survey ❑ Failure to develop a PDA 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 IA ❑ NE
Other Issues ��
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes M o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑„Yes �6 ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. <44� 0
30. id the facility fail to notify the Regional Office of emergency situations as required by the Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question lt): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
A1QV
ZL( J � �,�A l� �^ / slL �i� JLi -✓fir Cn .�.� /c /'� �.
C
n /
4, 2 ,c C^ ..✓i ^,
c � za .ten
2a f✓�'
mac( &
C�•n�
19O071-D
f`f P-'.� l/ �n %4 6 73Py
Reviewer/Inspector Name: Phone:
� n
Reviewer/Inspector Signature: �f�-�✓ �{ Date: J G
Page 3 of 3 21412014

Date of Visit: t(Q Arrival Time: 9 n- Departure Time: T-z S County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 'Z 55 q
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design C•prrent
Cattle Capacity Pop.
Dairy Cow
WWean to Feeder
35Y Z
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P.pultr, r
La ers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
I I
Turkeys
—TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes ENo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes
[—]No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
Page I of 3
21412011 Continued
,C

Facili ,Number: - Z.-
Date of Inspection: 5-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3P ' 4
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
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 No ❑ NA ❑ NE
[—]Yes [7j/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, notify DWR
7. Do any of the structures need maintenance or improvement? 0� ELI No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q N ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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 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
E:fNo ❑ NA ❑ NE
G3 Yes
❑ No ❑ NA ❑ NE
❑ Yes
No ❑ NA ❑ NE
❑ Yes ff'&o ❑ NA ❑ NE
❑ Yes El'No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping neFacp
rpoQvement? If yes, check [ ap
❑ Waste ApplicationZy Freeboa Waste
❑ Rainfall ❑Stocking Yield 120 Minute Insp
22. Did the facility fail to install and maintain a rain gauge?
propriate box below. Yes ❑ No ❑ NA ❑ NE
Analysis [—]Soil Analysis ❑ Waste Transfers Weather Code
ections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
❑ Yes I� JVo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number. -4y Date of Inspection. C'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ETYes [:]No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �lo ❑ 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 GJ i cm
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 DIo ❑ 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 ETNo ❑ 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CNo ❑ NA ❑ NE
EJ'No
❑ NA
❑ NE
[EjNo
❑ NA
❑ NE
La i"o
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.: z I
Use drawings of facility to better explain situations (use additional pages as necessary).
J l r uP�Lc�� X•'o��
Chip 3s� —2�oyO
21r r^ k sl � d� e Ir.I-✓cr
W T FV 0rrr-S
c4-- !t' Tt'A, 2 2 fie/ 5 >�� zo/3�olc� SG9
n,: ss.r� G✓.A- H..e �r.roMplek
1 / I wt.Ik rccorkS
Zyr r0 Ca (r h'Plr'^r �8'e -i�C'A6�be �e c(4()
n0 C pop yr`/j s
pUk- f�4, �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6C (Ioe\. f IA, t,r'fi rC,^rC�S
Phone:
Date:
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: P'houtine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 3� t Region:' 1�.._&
Farm Name: L-hw_ s;4nt "t'L Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Certified Operator: 11Q"+t
T
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: d�4
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Z
No a er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult .
Layers
Design
Ga aci �
Current
$o .
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes J20No
❑ Yes W No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes VNo ❑ NA U NE
❑
2. Is there evidence of a past discharge from any part of the operation? Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �J'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 21412014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):__
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[—]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Callo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ YesNo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Z 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
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
o
❑ Yes
No
❑ Yes
V�No
❑ Yes
7fNo
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �;(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 ,� o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: Q- a-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZrNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
PNo ❑ 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
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2No ❑ 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
dNo ❑ 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
WrNo ❑ 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
21 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
ONo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
6 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: OL52- 3 6 /- 2&
Date: 9 1 D- 'Q-Izl
21412014

Type of Visit: Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: gRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: r'"9-�+I-,
Arrival Time: M`
Departure Time:
County: �! M
Farm Name:
' j��
e, Gtefzv% j"%j/t/yI/\
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region- W�
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I JLayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P.oultr.
La ers
Design
Ca aci
Current
P,o ,
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes [-]No
[—]Yes [—]No
[]Yes [:]No
❑ Yes 0No
❑ Yes E5No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

I
Facility Number: Date of Inspection: "
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONO
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes in 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 �Z No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �/ I No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) i
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
VT
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IV 1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
X No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
jn No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
)6No
❑ 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 VfNo ❑ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes Vf No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

! `' . -
Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
7No
❑ 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
�TNo
❑ 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
`VI No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
4 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 r-yy7No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes K No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ONo ❑ NA ❑ NE
Comments (refer to question tl): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
VlT e�Gl
.1
b
a
�tiv, pia
eK•aav;s(�Incde�nr.SDy '
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ocJ�3b)-
[d`ptif�
Date: 3
21412011

Reason for Visit: URoutine O Complaint U Follow-up U Referral U Emergency U Other O Denied Access
Date of Visit: Arrival Time: 30 Departure Time: ®County: l)P Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: -,R ML 0 of a-c V 11 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: s'Tcl I
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
LOurrent
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
32po
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oultr.
Layers
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[—]Yes ❑ o ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑ Yes ✓[Nlo ❑ NA ❑ NE
Page 1 of 21412011 Continued

Faciti Number: -17 Date of Inspection,
Waste Collection & Treatment
4. Is stoiige capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes rNo
❑NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Wi02d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Vo
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 environmenta hreat, 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
dNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes 2 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?
s
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ �Yo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U1No
❑ NA
❑ NE
acres determination?
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
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesVNo
❑ 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 6 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 I _IKo
❑ 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 Ins ection: IZ
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNoo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑Yes
❑ 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
c ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Nc ❑ 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
E?I/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
Eff/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
[�/N o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ..No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ s ,� o I] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. 1
Use drawings of facility to better explain situations (use additional pages as necessary). I
�() p,ojj . cj-r&oA) Au(J FoA WA Sclat —to ot-. 42 - At -Tzf ►E o C sjsPEc_'saJ
iWLE S wA VVW,-Ld6- t✓AsiE F(um 31-182- ro sI -07lesug(,E
-I�USrEp' o'G /yea£ I �AN aprraL f 5A . o6TAD) &vrs j dd ,
Axco CaA1'T"i- uEEOE0, FAa4t4&p NAS I U2CHASC9 WEED G�JTRtY CH rvl�cA�
AP-0 Nxi_ AFPC-V ACr'� TIAMS(CA, .
5q j FAaMk 2 945 ASKED Fd &_� raL�_Ot.J — tle
wd J",)E IS —OGY 31 M4V POW 5ELOW Sror r��EL,
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
A Phone: %) ( lb—Iu
Date:6 & ) L
/2011

Type of Visit: 0 Co fiance Inspection O Operation Review C) Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Otheyr� 0 Denied Access
Date of Visit: 1 z'1 1 Arrival Timer Departure Time:® County: jr?� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 1 M d_l1+e AZF I y tkelm Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,outt .
Layers
Desigu
C•_a aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 0 o ❑ NA ❑ NE
❑ YNo ❑ NA ❑ NE
[:]Yes [(No ❑ NA ❑ NE
Pagel of 21412011 Continued

Facili Number: -
Fp-a49 TV i 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure- } Structure 2
�r-IIG N
22
2J No ❑ NA ❑ NE
❑No ❑NA ONE
Structure 3 Structure 4 Structure 5 Structure 6
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 2No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? - ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [-]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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?
❑ Ye
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑
❑ N
V
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ 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
o
777777
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
E
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 [2/NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ❑ No ❑ NA ENE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ENE
Page 2 of 3 21412011 Continued

Facili Number: ',j - jgjDate of Ios ection: y �}'j t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA
25. Is t}te facility out of compliance with permit conditions related to sludge? If yes, check' ❑ Yes ❑ No ❑ NA V
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA rNE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
eNo
❑ 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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El"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.-- «m
Use drawings of facility to better explain situations (use additional pages as necessary).
l5,) Dssc,�ssE.� AGo�►raM�s1" REc�,+�mE,✓,pA7-�oN. �2EQut/t�
�CaJmF,NTs nnl r'Rock55 aF �,s�t,rNcr F.�.�t.nS. LFt� r ���
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /� Vol
Date: a" Xt
24120,11

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint X Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: C10 Departure Time: ® 1 ` County: t X J /V
Farm Name: (—\(T)CS7cyq� C"E11' Owner Email: ���
Owner Name: �V CU I I fr�o�H� N E I HCv2CcA� phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oultr.
Layers
Design
Ca aeit
Current
P,o ,
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
[-]Yes [-]No
[-]Yes [-]No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Continued

Facili Number: jDate of Ins ection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
ONE
"'''�❑"'''((NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
lyl 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
,,7���'...��C///
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? 4
Waste Application y
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I `d No ❑ NA ❑ NE
maintenance or improvement? `71
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1 X I 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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
)ANo
❑ NA
❑ NE
0 Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
❑ NA Ipl NE
❑ Weather Code
❑ Sludge Survey
❑ NA NE
❑ NA E
21412011 Continued

Facili Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
�[
❑ Yes ❑ No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ No ❑ NA 1 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No ❑ NA I yl NE
Other Issues
]�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No ❑ NA 1� 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 L XI No ❑ NA ❑ NE
`y��'1
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 I T. I No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
Y'C
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No tKNA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
PMANDA CRINGSLDt�Q) °litm NAI0690Nom►s7(�NCDA
w(-_iLEa1VSITr_ To
(P- L)AUkATL- gL(LMUD04 C(Zc(�
.AIM c-L mA/L /9 wGLI-IT" ,R..EFbZT o�-- HIS
GiEcocnmE�►DE1i ic�IS
DID�TR► -r4pfT -TNE PI L�� }� qn �S-FO°/p covEa Ash w�commo�/
geq_ML&D
33. 1 (6F i R mr.ss�sE �� W. >V€; HER ct�—, I NAT
wE wa ACD 6C �sNSi%E.
�A(- (Zg A "C-SENrA7)u& w�_(LF Noy P(CESEN1.
-THIS (ZEPo2T
—Illy) 11��'s� wlt-�6E mAIL��
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 9�G/-/�`ito-�3a
Date: WN41z
21412011

Division of Water Quality
Facility Number 18 Division of Soil and Water Conservation
Other Agency
Type of Visit A
Co_mpliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
y uutine O Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: /I Arrival Time: ® Departure Time: County: UAI Region:
Farm Name: ( / _ WF_ 5 ic>JE C(LEEY- FAUD Owner Email:
Owner Name: 1 U I MC)Ly / V_F7ii[-QCCAITT 7Phone:
Mailing Address:._ �i • �x f—E/J%i/VS V I�'L� , / �/ ���f'� G�GO�
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: �� Integrator:
Certified Operator: lU + 1 fY)071Y�VF_T"gCL 7_r Op `jrj9 p Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o = , =11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
35 o ❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ 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: ED
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes xNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes
� No
"""X
❑ NA
El NE
❑ Yes
���`
No
❑ NA
❑ NE
12128104 Continued

•Facilit}`Number: —JR01
Date of Inspection RX=
2
21
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 IR% 9 Struc,Iure 2 Structure 3 Structure 4
Identifier: /O\t
Spillway?:
Designed Freeboard (in): I —I • S (• 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo
❑ Yes ❑ No
Structure 5
❑ Yes
❑ Yes
I
El NA ❑NE
❑NA El NE
Structure 6
❑ 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 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 ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7,1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes pt1 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
15. Does the receiving crop and/or land application site need improvement? AYes
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
ICI No
E❑
El NA
El NE
No
❑ NA
❑ NE
NNo
❑ NA
❑ NE
YNo
❑ NA
❑ NE
;XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or aay recommendations or any other comments a
Use drawings,of facility to better explain situations. (use additional pages as necessary)
't�Clvl� %lO 1 FINi> C(�( l(�RAT1t7T/�FOCZ�o�Ol�- t RSTONL}�
LpcF�� wAS �Fs
C pt,�c� NOT F-) N h adl� So I L R-CSc.t4' S
-rpl CS �F R�T+� w/�N �pAyS. ►gTrN : An+aaoAGat�3
Reviewer/InspectorName Phone: 0 NO
Reviewer/Inspector Signature: Date: —:�' )
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspectionm
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. 0 WUP 0 Checklists 0 Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
N No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑�aste Transfers ❑)&ual Certification
0 Rainfall [3 Stocking ❑ Crop Yield 0 120 Minute Inspections El Monthly and V
Rain Inspections E]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
NKYes
T�No
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
L21 NA
❑ NE
Other Issues
'T �`
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,.j,
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
V Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings: «.
CAN U�)L�(j?__ C,IACoc>nJ (_r—Car Lot. Ca c mP
(j sL_L J� )GC 1-9 Au«•�� {3E-rWcrvv StkNc ►54 OIZ7r3�. St y
EX-
e�s.�OC, 30)0 S (_ctiOG E — A
V69.6Tj 5ut!;yn ITTTc�
QC5 N� oNSI i C (Lc,?QE�NT47) UC - t2EC-0f2-DS W'tGIE +�rrT
w•A•
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ry'\ P
We pps
pE ��S • j} rr><7. AwtArvOA <41,VES
Fix 916- 3 -may
Page 3 of 3 12128104

Facility Number: — / bate of Inspection j
lj:7LEctJS IN gAD Si-)APC. SMpct G%aA„J c.00X-S SfDor-T4 ,A/
CcxEaACP , tom; S O G: wEEos IN
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ADS oR AN THINGiZE(X�RT / (�LEµsC- c,gcC
MEN ��9�-�3a� a� SENt) A LA: TT--h/
�S�vvsG wJ SG,L"�•GAL-IgQA?ION.
: � qc_S(2 �) ntb NOT FIND A CROP C.,I ECI� . �cCZA =
u,A�D w(i nr 30 oa%s -To ��JQ
- ablo cAL16RA7�cv i/ oR- ve �vr_ ASO
- IQ soles R-[Po2T o4t (yvc AsAPa A/Yo7HCR
WNE7►i15 FALL
A x
(. nAJ. AMAAlW GA)NES
Ip-350- OWL'
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et_,JQ w)Lc ee f319cK W
JUNE —too wit L G3 E
NO71 PIC-.p O2 ,v S„
Vl St%
7/25/97

(Type of Visit 3KCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit -Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /G %b Arrival Time/:�.F--C4 Departure Time: County: UN Region:
Farm Name:-1fl�ES jO.d� C2CE� Row -en Owner Email:
Owner Name: (E Mo / NE7NERCu'T I 7�r Phone: IJ2�--.09(0-AA?5 EyFr yy5
i Mailing Address: •0 � • q4 �eNANSUI�E, / C NSC I 'Q_4(!t9
Physical Address:
Facility Contact: 7�' Title: Phone No:
Onsite Representative: Cu/V C E.VE e-nuERGuT , Integrator: Fl q�7
Certified Operator. LeA U-'T Opera�Cerahification Number: «55
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: � J.
0, 0ll Longitude: [--A 0 0, 0«
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V,
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes VNo
❑ NA
❑ NE
❑ Yes ANo
❑ NA
❑ NE
12128104 Continued

Facility Number: -5) —,/$a Date of Inspection '� U
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
VYes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ANo
❑ NA
❑ NE
1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
/S,t�r�ucture
L Identifier: HIA1
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in): Ig
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
ElNA
FINE
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 'KNo ❑ NA ❑ NE
8. Do any of the strictures 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 ElNE
maintenance or improvement?
Waste Auplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes oNo ❑ NA ❑ NE
11. Is 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) M K A" LLk A PA CC
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
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 0 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes '�KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes 'R No
❑ NA
❑ NE
Comments (refer•to question #): Explain any`YES answers and/or�Sdy recommendations orany other comments. „;
a
Use drawings of facility to better explaftir situations ;(use additional;pages=asfnecessary):
m
T7XLA/, )S ct)lr_-)F-2 3G�q�Pofl
xtLCii> TU lF1cc 11V la-u;S ON
Reviewer/Inspector Name — r ,..w., e ms` """ .ah "_s w Phone: 516 -1 % 6-3'rO
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection:f „
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA VNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
0 El the appropriate box. WUp ❑ Checklists Design Map
s [I 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 ❑ �aste Transfers ❑Ynual Certification
[]Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections ❑ Monthly and V Rain Inspections O Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
0
)/ 11(_> l.7>
❑ Yes ONo
❑ NA
❑ NE
❑ Yes '&(No
❑ NA
❑ NE
❑ Yes 'ANo
❑ NA
❑ NE
❑ Yes ANo
❑ NA
❑ NE
❑ Yes ';kNo
❑ NA
❑ NE
❑ Yes ❑ No
XNA
❑ NE
❑ Yes XNo
❑ NA ❑ NE
❑ Yes No
El NA ❑ NE
��A
lyl ❑ Yes No
❑ NA ❑ NE
❑ Yes ANo
❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
❑ Yes 9 No
❑ NA ❑
NE
C�ir��GtA-, )oN lbu E Dolo
�uoGE sub-uc-� nub �i0
12)1� coCkP*V Mt sE>v� ASAP
ac)C9 3011_cSAMpLE c* PL1j
u
12128104

c 0 Division of Water Quality
Facility Number 3 0 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: �h4 RW N Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: I I(Yi(nLt El/fEF—CLA:rI
Certified Operator: JUEuk t" 07rWt1 %U&_T#ELCu7T
Back-up Operator:
Location of Farm:
Swine
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: oL 559
Back-up Certification Number:
o = = Longitude: M o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer 3 5 ❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
El Pullets
Li Turke s
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field [I Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
[I Dairy Calf
❑ DairyHeifei
El Dry Cow
❑ Non -Dairy
El Beef Stocket
❑ Beef Feeder
❑ Beef Brood CovA
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)?
Number of Structures: 1-1
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 IxNo []NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
N[No
❑ NA
❑ NE
12128104 Continued

Facility Number: — 18 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IX 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: LAGoO�I
Spillway?:
Designed Freeboard (in): n
Observed Freeboard (in): 0911
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
4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
!a 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
V No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PqNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
K' No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
09,5. no '5utwE Su6UELs JAI U . In1T&Nus -To a_erV'GUE
51-La"6E IAI toE
WIt_,L.- CAL-L- [K t00 D S 76 tnP(�ATC oN
PRoGRrSS
Reviewer/Inspector Name �M4ayoA- 6jw!E3
Phone: ci/Q" T b -+3cx
Reviewer/InspectorSignature:
Date: 9173Ug
12128104 Continued

. ..s.
Facility Number: ► — /%a Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 )o 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 _N4Vaste Transfers Annual Certification
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ED Monthly and V Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
y"d No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
t4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
4 Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IRNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Aj No
ElNA
❑ 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
M No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Do No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Comments and/or
12128104

Facility Number
Type of Visit Q Compliance Inspection
Reason for Visit O Routine 0 Complaint
Date of Visit: j t0//t%/O7j Arrival Time:
DDDivision of Water Quality
�
ODivision of Sob and Water Conservation
0 Other Agency
O Operation Review O Structure Evaluation 0 Technical Assistance
O Follow up O Referral Q Emergency O Other ❑ Denied Access
Departure Time: �County: U!fG7, J Region: //// IppV
Farm Name: �. mFS T/�/t�/� [ ��//�H %wt�?� Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
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
Other
❑ Other
Phone No:
Integrator• / /��4/
Operator Certification Number: 7 SS 9 9
Back-up Certification Number:
Latitude: u V� LALongitude: [-:--]° M, M
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
2 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
ffDairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures: FTJ
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �/No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes,yNo
El NA
El NE
ElYes YQ No
❑ NA
❑ NE
12128104 Continued

. F cility Number: — gz Date of Inspection I rry/i�f/oyl
Waste Collection & Treatment T�7�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /rE-l
NoElNA ❑ NE
a. If yes, is waste level into the structural freeboard?[IYes No ❑ NA ❑ NE
Scture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:y�—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (0
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 El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VJ No
❑ NA ElNE
8. Do any of the smctures lack adequate markers as required by the permit? ElYes X—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 El Yes 1dNo
❑ 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. El Yes , y� No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) l
❑ 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. Croptype(s) -'S.0 .
13. Soil type(s)
14.
i
Do the receiving crops differ from those designated in the CAWMP?
El Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,,,I,,,�(((No
/I[J 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
/VNo
❑ NA
❑ NE
Comments (refer to question ti): 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):
pu �S7 PoBT r nI , oN rar+� o/G
2,-2- Gzr,X t-;V_ • a���
/—p2�1/ffP7
O2 i�bU. ���-2.> / oPr15 / vfEO U / r/�1 4Gc/m�5
/�F,A% �r�5�`C7zpri �i✓.�T�AC.S ,69 [/��?�5,
Reviewer/Inspector Name S Phone: 9
Reviewer/Inspector Signature: Date:
12128104 ' ! Continued

a&I tyNumber: — 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
/I,�d No ❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design❑ Other
❑Maps
/
21.
Does record keeping need improvement? If yes, check the appropriate box below.
,.
R,(
Yes
❑ No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 0Waste 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
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No P(NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No ❑ NA
[I 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
XNo ❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ No /ffNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes XNo
❑ Yes XNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ YesXNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA'ONE
❑ Yes y_�/No ❑ NA ❑ NE
❑ Yes No No ❑ NA ❑ NE
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CZOOIP—ZDo��. �w l JP�P�z L I QPy Rev/cam
rJF_/1L
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FDm eL�fi✓� /s
D I G'iOBC5,C 3 4 �_/-/A-,A)DGY1 T), 12/28/04

I�.
(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I /f-/ Arrival Time: eparture Time: ounty:
Farm Name: / Owner Email:
Owner Name: �Z,410T tf / �, ✓/ 7_104- L rU7-7 Phone: _
Mailing Address:
Physical Address:
Region r
Facility Contact: Title: Phone No: J
Onsite Representative: Integrator:
Certified Operator: �� Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =. = Longitude: =o Q, =
Design Current
Swine Capacity Population
❑ Wean to Finish
Design Current
Wet Poultry Capacity Population
❑ Layer
Design Current
Cattle Capacity Population
❑Dai Cow
Wean to Feeder 2g
Feeder to Finish
❑ Non -Layer
❑Dai Calf
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
Laersow
❑ Non -Layers
El Pullets
on- airy
El Beef Stocker
❑Beef Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Beef Brood Co
Number of Structures:
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9No
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

C
Facility Number: — �j Date of Inspection
/ I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes XNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Strutt re Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:t� O
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.)
/,_,,yJ/
6. Are there structures on -site which are not properly addressed and/or managed
❑ IQ 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 ,1.,4,/No ❑ NA El NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes /Ld 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I,Q 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? ❑ YesZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? VYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑❑ Yes V No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ElNA ❑ NE 21
❑ Yes ' ZNo ❑ 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):
C� �r�On�>/1a� Aooz �✓,i/�-Of/J
Avp u r / /��/, �i/.�� ✓ !C i�P /%ZouJF /�
\51o1 zT /o AIA o�� ��/r�lJItDA
o-ASN�.�✓
Reviewer/lnspector Name
Reviewer/inspector Signal
Page 2 of 3
Phone:
Date:

:r
Facility Number: — Date of Inspection�3/O(ol
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
,Ld 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 0Design []Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
VrYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield L2 120 Minute Inspections ❑ Monthly and I"
Rain Inspections Weather
Code
22.
Did the facility fail to install and maintain a min gauge?
❑ Yes
[/No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
777777❑ No
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
'21,NA
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/No
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
/❑
El NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
rrr
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 11 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes I/J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes V(No
❑ NA
❑ NE
Additional Comments and/or Drawings:
5/ �g y OFF � o
ZD) A1% 'D v�_Sae'-Ll 0)", �l�COQOt,
�,� sow � L�%q--��.-2„ �jC �OPt/ ®� Leo.✓ ,��s�
/70
J 00D16 .
Page 3 of 3 12128104

oo�✓
:r

F D.1
Fox No. : 9102962122 May. 05 2006 10:11AM P2
o f VIA Michaoi F. Easley. Govomor
William G. Rosacretar Jr.. Sey
C�( y ��\�(� North Carling DeparaeMt of Errwn ment and Newel fieeowees
i r Alan W. Klimek. P. E-, Oiiector
y Divielon of Water WnKtr
October 1, 2004
Ivey T. Nethercutt
Limestone Creek Farm
PO Box 702
Kenansville NC 28349
Subject: Certificate of Coverage No- AW S310182
Limestone Creek Farm
Swine Waste Collection, Treatment,
Storage and Application System
Duplin county
Dear ivcy T_ Nethercutt:
On Junc 11, 2004, the North Carolina Aii4sion of Water Quality (Division) issued a revised State General
Permit for swine facilities. The General Permit was issued in accordance with the directive of Senate Bill
733 (Session Law 2003-28).
in accordance with your application received on March 10, 2003 and in accordance with the directive of
Senate Bill 733, we arc hereby forwarding to you this Certificate of Coverage (COC) issued to Ivey T.
Nethercutt, authorizing the operation of the subject animal waste collection treatment, storage and land
application system in accordance with General Permit AWG100000. The issuance of this COC
supercedes and terminates your previous COC Number AW S310192 which expires October 1, 7004.
This approval shall consist of the operation of this system including, but not limited to, the management
of animal waste from the Urnestone Creek Farm. located in Duplin County, with an animal capacity of
no greater than an almin2l average of 3552 wean to Feeder swine and the application to land as specified
in the facility's Certified Animal Waste Management Plan (CAWMP). If this is a Farrow to Wean or
Farrow to Feeder operation, there may also be one boar for each 15 sows. Wbere boars are unneccessary,
they may be replaced by an equivalent number of sows_ Any of the sows may be replaced by gilts at a
rare of 4 gilts for every 3 sows
The COC shall be effective from the date of issuance until Seprembm 30, 2009. Pursuant to this COC,
you are authorized and required to operate the system in conformity with the conditions and limitations as
specified in the General Permit, the facility's CAWMP, and this COC- An adequate system for collecting
and maintaining the required monitoring data and operational information must be established for this
facility. Any increase in waste production greater than the ccrti find design capacity or increase in number
of animals authorized by this COC (as provided above) will require a modification to the CAWMP and
this COC and must be completed prior to actual increase in either wastewater flow to number of animals.
Please carefully read this COC and the enclosed State General Permit. Since this is a revised State
Gcagral Pcrrtrit, it contains new requirements in addition to most of the conditions comaimd in the
previous State General Permit_ Fnclosed for your convenience is a package containing the new and
revised forms used for record keeping and reporting. Please pay careful attentio tot r�AUGIiug
and monitoringeonditions in this permit.
Aquifer Protection Section-Arimal reading Operations Unit
1636 rrair Swvloa Center. Ralegh. Noah Calm VK-9-16M
phone. [phone] I FAX [phone]aff I W"et h2c wr.state.nc.us
An Equal Dpli tt mftyrAMtrmairw Action Empbyw- SM Rerydedlt0% Post Consumer PS M
W Carob a
�turi

FR6tt :.
FAX NO. : 9102962122 May. 05 2006 10:12RM P3
if your u ante Utilization Plan ha; been dcvcloped based on site specific infomtation. careful evaluation
of (inure snniplcs is necessary. Should your records show that the current Waste Utilization Plan is
inaccurate vov will need to have a new Waste Utilization Plan developed.
The issuance Of this COC dues not cxeuse the Permitter Boor the oblioati()n IQ comPly with all applicable
Inw<. rules, standards, and ordinances (local, Niatc, and fudcral). nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Upon abandonment or depopulation for a period of four years or more. the Permitice must submit
documentation to the Diviiior. demonstrating that all current N-RCS standards are met prior to restocking
of the facility.
Per I SA NCAC 2H .0225(c) a compliance boundary is provided for the facility and no new water supply
wells shall be constructed within the compliance boundary. Pcr MRCS standards a 100 foot separation
shall be maintained between water supply wells and any lagoon, storage pond, or any wetted area of a
spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAW -MP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C. including civil penalties, criminal penalties, and injunctive relief.
If you wish to continue the acrivity permitted under the General Permit after the expiration date of the
General Permit, an application for renewal must be filed at least 180 days prior to expiration.
This COO. is not automatically transferable.. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership_
If any pans, requirements. or lirnitations contained in this COC are unacceptable, you have the righr rn
apply for an individual permit by coniacrinR the staff member listed below for information on this
process. Unless such a request is made within 30 days, this COC shall be final and binding.
This facility is located in a county covered by our Wilmington Regional Office, The Regional Office
Water Outlity Staff may be reached at [phone], if you need additional information conecrnine
this COC or ncc General Pemtit, please contact Duane Leith at [phone],
Sincerely,
vG �/
fi,r Alan W. Klimek, P.E.
Enclosures (General Permit AWGI00000)
cc: (Certificate of Coverage only for all ce's)
Wilmington Regional Office, Aquifer Protection Section
Duplin County Health Department
Duplin County Soil and Water Conservation District
Permit File A W S310132
APS Central Files

Murphy Brown UC
Kenansville Division
May 4, 2006
Murphy -Brown, LLC
Kenansville Division
Contract Growers
Limestone Creek,
785 Hwy. 24/50
Warsaw, NC 28398
If your farm is currently covered by an NPDES permit, as a requirement of your permit,
you should have completed an annual certification form that summarized the
environmental activities on your farm for 2005. if you are not under an NPDES permit,
ignore this letter. You will recall that one of the questions on this annual certification
form asked for your annual animal population average. Your annual average inventory,
based on the information in our tracking system for groups closed from 01 /03/05 through
01 /01 /06 is as follows:
Facility ame
Limestone Creek
Grower No, Permitted Head Actual Average.
97537 889 860
This information should be documented on your annual certification form, which should
be sent to DWQ by March I, 2006.
In addition, a copy of this correspondence should be kept with your environmental files.
If there are any questions or concerns regarding either the information contained in this
letter, or other environmental issues, please feel free to call me at [phone].
Sincerely,
Kraig Westerbeek

60.
48.
46.
44.
42.
40.
30.
36.
34.
Lower Left
30 Mash Surface
Propound
Project: KENNETH BOSTIC
Drawing: 1776 ADDITION
Number:
Location:
Bid Date:
Engineer:
Owner:
Estimator:
Prepared bW: using Sitswork
7ssh Surfa0a

LA
IclaL_ cross s��TLo�I VIEW DV A DAP- n''}AEG
PIZ Rti!_cN'AQG�E .DEs1��
43oTTDM bC suA'P IN41E0.�" OF butlt�l WIPE
El �V
4-5,67 Tot RI_ DESIGN
sToAY+�F �V.VeV' tl-fJ_.36 �ETTLL� �
cD rtNP-VAeNr BLDa, 4-5.11 TOP or DIKE
FiN1�11eD FIOOR EI+EV����
TOP of PAD
1
1WVPRT of Dual
�{_4•SI E}cV.
TREatNnENT , / -`
� lnGooR to -
suppDfzt bEpTk J
35• r 1 I
oOiToNA ELF:
iJO• -To Pt�aTEGT' pbpal.�if yE�
,rG -
W14Ft4l�(�IrA'� DF vN7vITA(bl.� MAt�t�InL
4dt15.�Ec A�MIN owrrl.,�
-Tu 96
6dM -rep r+d��GS J�oVEO AA
0 AT t`.

Surfaces:
Proposed
Existing
Cut:
Fill:
Tight Volumes
6080.94
5294.40
Difference: 786.54
All volumes are in cubic yards.
Expansion (t) Expanded Volumes
0.00 6080.94
90.00 6882.72
Net Import: 801.78 7�k
Grid cell size: 5.95 by 6.01
-original -scale: _100_OOft/in-
Project: KENNETH BOSTIC
Drawing: 1776 ADDITION
Number:
Location:
Bid Date:
Engineer:
Owner:
Estimator:
Prepared by: using Sitework
A-gom TEE )"Umes 4A2
Nor RELA-rWr- lJE
-� FAcr -rW*.-r 00' w
r3 ALR*Aby STAZr ,
T—

0
plot of all data for the surface:
Proposed
Project: KENNETH BOSTIC
Drawing: 1716 ADDITION
Number:
Location:
Bid Date:
Engineer:
Owner:
Estimator:
Prepared by: using Sitework
1
.00
00
38.00
i
4J:00

qls. i 1
4641
rimeter
Plot of the contour data for the surface:
Project: KENNETH BOSTIC
Drawing: 1776 ADDITION
Number:
Location:
Bid Date:
Engineer:
Owner:
Estimator: _
prepared by: using Sitework

36.00
841 z6. 11 46.
.36. 1L
35.11 z
35. L1 35.11
Z
z 46. 1
3k46.it 4
43. 00
.ee
00
17
plot of the eloping lines for the ourfaee:
Proposed
Project: K'ENNETH BBOST C
Drawing:
Number:
Location:
Bid Cate:
Engineer:
Owner:
Estimator:
Prepared bd: using Sitework
"1

IType of Visit R} Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit JO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ( Arrival Time: Departure Time: r County:
Farm Name: /f S�pr✓f_ ��&& /! 1 Owner Email:
Owner Name:llirs/I�FTfff2Clr'/r Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 2 O � t� _&W_ Zdd4/
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Integrator: s
Operator Certification Number:
Back-up Certification Number:
Region: (c!/
Latitude: [�o [, [ Longitude: =°=' F-1„
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
Q ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ 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
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FiEl
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 A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
jo No
❑ NA
❑ NE
12128104 Continued

)facility Number. — Date of Inspection / B
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 l Structure 2 Structure 3 Structure 4
Identifier: oll
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 946
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Z No ❑ NA ❑ NE
❑ Yes V1 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? PTYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Oyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
m No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
20 NeFo 14640 Al O.F59ant5_ 4&f G os,
GR Zoos �J��fr �EcoR� .V.�t1 /Ilc✓� D nsl
Reviewer/Inspector Name ,�- II'-^ ? Phone:
Reviewer/Inspector Signature: A r Date:

Uacility'Number. — Date of Inspection / O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 21 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists oDesign El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ,� Yes ❑ No El NA El NE
❑ Waste Application ElWeekly Freeboard ,CJ Waste Analysis ElSoil Analysis [IWaste Transfers ❑ Annual Certification
ElRainfall ElStocking yJ Crop Yield Z 120 Minute Inspections ❑ Monthly and l" Rain Inspections ZWeather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [21 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�t
I[J No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z 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
VfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JO No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
C
_'g
No 44/ s�/� /h✓9�ys�s to lovsse %m�z✓� � 'F�e �/S/ems
AWW
'/1lEho 7S��a> dls G AAW
n)AAo _(Po 16640 CRovp5A&d9 R-eORD6.
olfqI105-
Saz� 7Ks�/1 EPAa> t�fo�cJ,�p o.J �2mI���N�/-0�0 F2
L9aoor fv��.i T.sF /199+�k6.e, t,I //0'.Zll 41�az✓<-cr�
7v
(5i /�� �., �� F tea,✓ �et9-s s F� � ,B�„� uGL9, �zf�os /%%y /yc�
VQFsC®in rnF.�o '�cr.7 , /.fJa�i� �`in �i� , ��zo,vyr yoaN7M ' ��sou7
& slD�t FG���s �, 5 ,�„ro,✓i > ,cis R10-37_4-q9T#

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit XJCoRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date Visit: Tune: / aU
O Not Operational Q Below Threshold
/EfPermitted j "Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above- (Threshold: ..... ..... _..... ...
Farm Name:..... fZ3 E..... . i ......� R:r✓_t ................._._ County: .......
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: .��.�L-.__1�7.✓_I2:......... ....................
Certified Operator:
Location of Farm:
Phone No:
_.._._.._..._.____.. Phone No: _._.____._._._...._......_..._......
Integrator. .... ..._..... w.,&_l_�. .............. ._.....
Operator Certification Number:._ ...........................__.._....
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' ='[ Longitude =• =' ='{
Design
;` Current ' Design Current_ Design Current
Swore ,Ca acitY,
y
a Cattle dlation
Po elation Poultry ` =Ca aa' >.Po `alahon , Ca aci
Wean to Feeder
Layer
❑ Dairy
Feeder to Finish
_; ❑ Non -Layer
"'
No -Dairy
Farrow to Wean
ry
Other -3
Farrow to Feeder
a
5
t Total Design Ca'-- tt6
❑ Farrow to Finish
Gilts
x : Total SSLWa
Boars
v NimberefLagoons EF=� -``.+ -,
Disebaraes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _......._.1.0.... _............ ---------------- --------- --- .._._._------------ _....... _... ...................
Freeboard (inches): `a q
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes _❑ No
El Yes k! o
El Yes 0 No
❑ Yes No
Structure 6
12112103 Continued

Facility Number: —
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(If any of questions 46 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 smctures lack adequate, gauged markets with required maximum and minimum liquid level
elevation markings?
WastepApplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN
12. Crop type
Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
�) S &o
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes 0
No
❑ Yes ❑ No
❑ Yes QNNo
❑ Yes QN
❑ Yes No
❑ Yes
❑ Yes
❑ Yes ZVNN9
No
❑ Yes
❑Yes
❑ Yes
Yes QN
❑ Yes No
❑ Yes ON/o
❑ Yes :2/
❑i <N
[]Yes
❑ Yes
Comments (refer to question #) Fzpbun any 1 ES answers and/or auy recommendations or any other comments
Use drawtugsof facility to better exphun sttoatioas (ase ad&6oua1 pages as necessary) ❑Field COPY ❑ Final Notes
(5, CRd? 0000— OrcCD4 ZPAf"%A-Mc1JV- AJ Q Z LA4Z,9'(_ PYVotAJ7S of 6_)3�DS.
f LEASE kMoJE vC.fl BWt­F�S tJ(_ WA`s' X� Q-3
CarxTT.NUE MAT_0- &*0CE O�' Dzr:-E SOI-Ae 914aU@S 3T_tLL-
�C t XC)5 :r
rY—.�—a».+. in^ • A" _Y"yra <Y 'fiG`.^.!.•. _'^__^F^Y"Cy^' nF'i '• �. "`r _ -' Vim.
Reviewer/Inspector Name a 4� � _ ,R(4J(✓C,{_-� . ,;,��_a���, � .,,,� =^1 �c-=�-``� �' s� aw
H
Reviewer/Inspector Signature: Date: o
12112103 Continued

Facility Number: `�J' _) 8Z Date of Inspection r l
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 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 _HNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LKO
❑ 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 6 No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes _ N9
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes BN0�
28. Does facility require a follow-up visit by same agency? ❑ Yes 0'N/%
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes B No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
ddtuonal Commenu and/or Drawings } `Y - y s'
12/l2103

V; A
Type of Visit '91 Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
El Permitted Q/Certifled [3Conditionally Certified r0 Registered
Farm Name: /��i £K ram
Owner Name: 2 ✓�-� � ET
Mailing Address:
Time:
Date Last Operated/oyy/�bove Threshold: _
County: l�/ypz�_n/
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: 1QZA'Q%)4 Integrator:
Certified Operator:
Operator Certification Number:
Swine []Poultry []Cattle ❑ Horse Latitude 0' =` 0 - Longitude 0' �
Farrow to Wean
Boars
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 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?
it. 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 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 95
05103101
❑ Yes I/J No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑(((No
❑ Yes
El Yes
,�,I(No
/IL1 No
❑ Yes
�No
Structure 6
Continued

r, "s
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6wasanswered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? es ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? //❑ Yes FrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes pZlo
11. Is there evidence of over application'� ' Excessive Ponding PAN ❑�fdraulic Overload ❑Yeso
12. Crop type ,P E.Pn9L117A iQA-i!i✓ / .E�EO�
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Nknagement Plan (CAVR(4P)?
❑ Yes
)] No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
�No
b) Does the facility need a wettable acre determination?
❑ Yes
o
90
c) This facility is pended for a wettable acre determination?
❑Yes
15.
Does the receiving crop need improvement?
❑ Yes
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,Y,JNo
C(No
Renuired
17.
Records & Documents
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
/
�d No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
i
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
/No
Id No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
/�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field CODY LJ Final Notes
NEED �o iiio w-�Nlsa��E�_,(JzK�lJa�iM'2
orf G�t� �C"W�?sf �Rl2ZGR7�©�✓ 1"all a / � �� �� /��n/t/FO.
�FieF /441EAR5 ' jgee- X 3,r1ja > S
Reviewer/Inspector Name
Signature:
0 1 1, 6-
Date:
05103101 1Continued

V %
Facility Number: 31 — Date of Inspection �-=�-
or 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 new 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 2�No
❑ Yes No
❑ Yes No
❑ Yes /yam No
❑ Yes VJJNo
❑ Yes 2 o
❑ Yes ElNNo
Additional Comments and/or. Drawings:...
�� LF14KziJ� SaME, A-',CCN1V1F'1LlO
�G 50f
�pu 5 E$.•
Q75
�zE�o �2 % P� �,vE•9>2 ®7o-
cjFR m u0/f , s
f�os
gz-
20171
rl �4G0 Nod /�GfFTF� /T sue' JA-mPLF_ /CERa2 � 02
1 Ls✓ OQ��,�, -� G1Jz�
05103101

t� [-Division of Soil and Water Conservation - Operation Review• - -
E3 Division of Soil and WaterComervation - ee ComplanInspection
ivision of Water Quality --Compliance Inspection
E3 Other Agency - Operation Review ... -
lip
Routine O Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review O Other
Facility Number Date of Inspection
��yJJJ Time of Inspection 1 D: tI 24 hr.
I] Permitted I rtit�ieeyd� Q Conditionally Ceer�ttiifieedd; / 3 Registered � Not O erational Date Last Operated: ........__-...-....-_.
I.enli %.IGNI f 4/...................._........... County: .............................................................. .......................
Farm Name: .................... .............. z ........
Owner Name: A—V,41/lllf-4-- r J(1577 ILI Phone No:
Facility Contact: .....UY.f1W .......... .. .. ........... Title: .,�.1. .... ,.J�i.�'i�/i�.s........... Phone No:...................................................
MailingAddress: '* ........ * ......... . ............ * .. ............. ...... ** ......... ...........
ddress:............................................................................................................................ 4.....................,
/t
Onsite Representative: ..... _ .. . ......... ..... .. ...................................... Integrator:..................../...................................................
Certified Operator:................................................................................................................ Operator Certification Number:.........................................,
Location of Farm:
Latitude =•=' =11 Longitude =• =' ="
Design Current. '
_•Swine --Capacity Population Poultry`
Wean to Feeder
355
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons.
Bolding Ponds / Solid Traps
Cattle _
❑ Other
Total Design Capacity
Total SSLW
Current -
❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System '
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 observed, was the conveyance man-made'?
h. 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? (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 2 Structure 3 Structure 4 Structure 5
Identifier: 22% t�
............ Freeboard (inches): .......31...... [iL(.�K..................................................................... .............................
. .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes b(No
❑ Yes ❑ No
❑ Yes ❑ No
---AA ,
❑ Yes []No
❑ Yes VNo
[]Yes 0,No
❑ Yes y No
Structure 6
❑ Yes �No
Continued on back
3/23/99

Facility Number: — r% 2 Date of Inspection
T/
5.
Arethere. aiy immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
XNo
seepage, etc.)
TTTTT"'lllll
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
gNo
(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 maintenance/improvement?
❑ Yes
�Io
/'"
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
gNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ZNo
It.
Is there evidence of over appli ation'? /n ❑ Ponding ❑ Nitrogen
6.1,
Yes
qNo
12.
Crop type
.................... ....... ..5................................................................... ............................................................... .......................................................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
15�No
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
S(No
15.
Does the receiving crop need improvement?
`-Yes
❑..�,,,///No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
',,,..\ o
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[g`No
'� \�
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
_
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
10
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�io
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
'�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
//Fyy1No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes
fJflNo
E' No.vio anon§ oc deficiencies .were noted ddrink Aii visit:. Yoti will.retieive nix further .. .
• cdrrespbtidehee: abbitt: this :visit .:.:.:...:.:.........:.:.:.:.:.:..:.:.:.:.:.. ; • : • : • : • : • : • : • : • : • : • : • :.. .
Comments (refer to question.#): Explain any YES answers and/or any. recommendations or any. other comments.
Use drawings of facility tobetter explain situations. (use additional pages as necessary):.
.
r) Wadi- � i�((�'�r,�r%( cry OVA ;� �� p
5P - � r l / WL` S/ S
a Goo , l CUJ
s�2 hf� P � 16 - Ovt�v.- t� U 1 alKt4-�+"t P+(/V r w- � 2 ct U 1, F,e
P
SC 6M/d"r e d a y to i3 jM wu P
Reviewer/Inspector Name ('rp>Ar %y%/- t/t 1 - _ �•'j - - -,
Reviewer/InspectorSignature'- " C.1 .1 .. 1�/1l�t//� Date: ���,��a���/ I1/6/99

Facility Number: -I)— [)are 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 ❑ Yes '4LUo
liquid level of lagoon or storage pond with no agitation? 1
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 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 $ZNO
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 VNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [No
3/23/99

-
Division of Soil and WaterConservation =Operation Review. - e
s.. El Division of Soil aid Water�Conservation Compliance Inspection
Division of Water Ouallty =:Compliance Inspection
Other Agency-;OpetakonRevrew �
151 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number ( Date of Inspection
Time of Inspection 24 hr. (hh:mm)
[3 Permitted ; C1'ertifi�e(d, i7 Conditionally Certified [3 Registered 0 Not O era[ional Date Last Operated: ........................_
Farm Name: .......-tLzVLYI1:.-.r AAAL..... f-fY.�.......................................................... County: ...... ���ira....................................... .......................
Owner Name: .......................... 4'lv4l C-.......W.-I(I................................................. Phone No:...N1).2--VK-qZR7 ..............................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ..... 1� ... 14.....$3.1 .............................................................................. .......... 5?.�G11.ate .... i_.G................................... L )ii
..........
Onsite Representative: ..... .K:k`b:N:h-._ ........... n....�12XlnAll. .................. Integrator: ... ...Ct,.¢r.0.��..............................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
on.....c45....._a .k.._ .......1...._D..L...t..D:r>..milts......x.ctk-k......a .........Cans, ...... .q.L.r`..... L:41.... 54..1:...........................
...........................................................................................................................................................................................................................................................................
Latitude =•=' =" Longitude =• =' =11
Design Current ,,-Design ..Current :. , _ Design . Current,
Swine Capacity Population Poultry - -
p y ulatio p rY = Ca-acity_Po elation .Cattle Capacity Po ulation".
Wean to Feeder Z ❑Layer ❑ Dairy
❑ Feeder to Finish 10Non-Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder _ ❑ Other - -
❑ Farrow to Finish - Total Design_ Capacity 355 Z
❑ Gilts,
❑ Boars_ "' Total-SSLW
Number of Lagoons. 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area _
Holrhrig�Poiids /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �Mo
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) ❑ Y e No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [B No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [P No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: & `-
Freeboard (inches): ............ .................................................................................
...............................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

acH6%Nuru va — wy 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 Pending ❑ PAN
12. Croptype ,novmrt rlti ON1 'iw 11
13. Do the receiving crops differ with those designated in the Certi
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?
ON=
Animal Waste Management Plan (CAWMP)?
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?
.' dVo • .....s:oe deficiencies mere .........
tg this:visit; You :will rebeiye Rio fui ther
ctirresnotideikce: abauf this visit: :::::::........................... .
s 1�U• 6�-d �ek her --fie ru�vrh ��. ( o, ocr, d:t-. ty M
T Cor�nVe. a Q"avn veykt r.v3t- d kiu wall S
5. LAfm M&Aur s kOJ13 6� exJ"ed it) Wei Sthe. Lt.v, o F •Ie� j v_
i'A-c. ro o, " wA delern„roit'on,
(s, Cat%jjnue e. '.rts our 6py"de. fn FPIJ f S,
is. 1rA9�p d2Si�r, e. 000 �M ir, CAWMa.
Iq. Se(iara� I& -L 9iwJltj be,- Q t, ;i— ec�(• f VD� Lyl �,
❑ Yes 'I No
® Yes ❑ No
❑ Yes ®No
0 Yes ❑ No
❑ Yes [21 No
❑ Yes (9 No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
(ZYes ❑ No
®Yes ❑ No
❑ Yes ;0 No
❑ Yes 19No
® Yes ❑ No
® Yes ❑ No
❑ Yes ® No
❑ Yes lg No
❑ Yes No
❑ Yes No
❑Yes No
❑ Yes V1 No
I
Reviewer/Inspector Name I"
Reviewer/Inspector Signature:
Date:
3/23/99

FJ
•Facility Number: 31 - 18y Date of Inspection Tj ys
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
R No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
®No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
KNo
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
'J] No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
S No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
D9No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
A No
3/23/99

0 Division of Soil and Water Conservation ❑ Other Agency
5] Division of Water Quality
Date of Inspection 10
Facility Number 1 '-^—Z
Time of Inspection ff-24 hr. (hh:mm)
0 Registered IRCertified
, (3 Applied for Permit [3Permitted E3 Not Operational Date Last Operated: .............._.........
Farm Name:.......... axYUXY�.....fbn�kc�.... .t'kir!4....................................................... County: ....... bqkm ...................................... .......................
Owner Name: .....................44Vl CMrx......................................................... Phone No: ..�. P)..218:-..4Z;UZ........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: .... .k.K.1...... $.31..................................................................................Beu.Lo.u....I.../4.c............................................Z BSI $...........
OnsiteRepresentative:........_ n......... ......................................................... Integrator: ........ C'Q'r.vaLt5............................. ...........................
Certified Operator................................................................................................................ Operator Certification Number:
Location of Farm:
Latitude =•=' 0" Longitude 0• =' =I.
s Design Current;- Design _ Current Design , Garrent
-Swine .- ,Capacity. -Population: Poultry Capacity�Population Cattle Capacity P_opolation
x,c
` Wean to Feeder I0 Layer ❑ Dairy
a ❑ Feeder to Finish ILI Non -Layer I I`... ❑ Non -Dairy
_'. ❑ Farrow to Wean-
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts -
m ❑ Boars Total SSLW .'
Number of Lagoons /',Holding Ponds 0 ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
L4 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?
N I�
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
U9 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 lagoonstholding ponds) require
❑ Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Facility Number: — ]gZ
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures (Laeoons.HoldinQ Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.*Z
...................................................................................................................................................................................................................
Freeboard(ft):.......... ............................................................
10. Is seepage observed from any of the structures? ❑ Yes 1} No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? ® 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 j No
Waste Application
14 Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............._�r"V A-.........................................................,.................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes F3 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18.
Does the receiving crop need improvement?
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24:
Were any additional problems noted which cause noncompliance of the Certified AWMP?
PYes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
(9 Yes
❑ No
0• No.violtitioitiorddiciehdis.wen iioteddtiring this:visit. .ou.wili receive naflirih&.
• correspoodeitce about Phis: visit: • ::: ; : • ; : • ; ; ::::: ; : • :: ; : ; ; � ; � ::: ; :: ; : ; -
I'r- CcnlinJt- ev6ry do Veaetr}c. ka'va. dills t,�a115.
Ig. �efnur�a 51nW10 i.e iJmPro+tt] 1r 5�rtirt' tq9.
tz. I cgcc JW,; • s1 1� be %r r LUIrk,
LA-/LSov"-VQVmC `` oQ VF re\60a _ Qv� S(hy,1�gv0.1M1
i n \61 p 0. J �.11
�ry'r �J%Lrs/ se.'Ytl4'k shwj be
ikt L. Il5
E,ct �cs s vou) be su�w
Q�v
at\j 't" wt,sk-
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �.re _ l' _ A - Date:

t 0 Division of Soil and Water Conservation 13 Other Agency
,® Division of Water Quality
Routine O Com taint O Follow-up of DNV ins action O Follow-up of DSWC review O Other
(���� Date of Inspection D
Facility Number Z
Time of Inspection 24 hr. (hhanm)
E3 Registered 0 Certified 13 Applied for Permit O Permitted JE3 Not Operational.......................... Date Last Operated:
Farm Name: ...... .!.-AArA4.....I....-u........ rki..q..................................................... County:.../�i1/ 1.!1.................................................................
Owner Name:......... � hlul ''./I..9?0jQ4�i� 1L.....................................................................
� Phone No:..q( V1-5.Z.-.. y�.ei.............................................
Facility Cantact:......).141A SI V° I�G....................... Title:........Q4?! 4...................................... Phone No: ... (AIP�.z:9.�..:.`.�.� 47
.pp........ p
Mailing Address:....U.,&)l........... ..3-1....... &,L)4V.;Jkt.... 9!;:................................... AT.01.........
Onsite Representative: ...... 1^C4tt:t1.I"►\.... LsC!.G........................................................ Integrator: ..........cSu'.Y..R.11.5....................... .............................
Certified Operator............ ...... R......... g}G pj�t�y_ r� Operator Certification Number....
Location of Farm: /
Latitude =• 0' =" Longitude =• =' ="
Design
Current,
Design Current t `, rt Destgnb Current
Swore
Capacity
Population
Poultry Capacity Populatwn P`- a
,,i
❑ Layer I Dairy ,
Wean to Feeder
3S J-'
JE3 Non Layer I Non Dairy
`. ❑Feeder to Finish
a ❑ Farrow to WeanYt
❑ Other d
❑ Farrow Feeder
.,. to
_ �F .
" " ..Total Destgu Capacity �j 5S'Z'
fr,
V , .., Total m..
❑ Farrow to Finish
[I Gilts
1•° ❑ Boars
Number of Lagoons / Holding Ponds ©, ❑Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
I ''�
T
', ' ,' ' ^ ❑ No Liquid Waste Management System ` e
,.m
.a-.` sue=
av
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes $j No
❑ Yes I9No
❑ Yes W No
❑ Yes 14 No
►) A;
❑ Yes ® No
❑ Yes
R No
❑ Yes
® No
C9Yes
❑ No
❑ Yes
® No
❑Yes
JUNo
Continued on back

n
Facility Number: 31— L
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lapoons.Holdine Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
.......................................................................................................................................
Freeboard(ft):...........2......?.....................................................................................- ...........................
10. Is seepage observed from any of the structures?
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 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?
Waste ADDlication
❑ Yes Id No
❑ Yes
1A No
Structure 5 Structure
................................................................
6
.................................................................
❑ Yes
WNo
❑ Yes
® No
t.Yes
❑ No
❑ Yes allo
14. Is there physical evidence of over application? ❑ Yes Oa No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. erDP type ..........._bp _!!�udo ..................................... .......... ................... tr..11....g, o:.........................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes V No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is ihere 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.vi6latioitsoi deficiencies.were noted'duiitig this.visit. You.wiU receive ii6 fiirthei-.
correspoitdetice about this visit.-...
❑ Yes ® No
® Yes ❑ No
❑ Yes No
® Yes ❑ No
❑ Yes ®No
IN Yes ❑ No
❑ Yes ® No
0 Yes 1W No
® Yes ❑ No
S, Lot- area zt. Peld be {filed, railed avj rei eded- lsrvsl— plus tr\ UNAA --Wd
loe nrraver� ow�� altaS �tSeerjtd. Lead, tie itvtr �jaa to Js d;(a�•&rr "dLQ ydtn4t
It �rosccr e�♦s oe irw /�vlu wall quad �a �ell[d wt(L_ am tx+ K e cd• diet ti Kc atlt
sleovl) hz motrcd- &et areas sl old be vtcecded r
Is. &rMA,coop t, &t1d ", s64u1) (ae- .mYwved,' S�fUr `9$.
1z kselbroie lkR z (?e rr sk j) be uttd for etwb. Rtid, Correcf acvcage fte(r)s sl,wl/d
d�x.�rYw4rt.J. U k wash �y��slI. Ccrt �%tw'�t6r fern. t6uj t) be ;� crvkt~c 11brt-
Mtird3tn ps {xet ouwo(sPl.rd j, UNitz, 0051re. U`I;1cta{ Oe, alto allows 1u)6 14
cre.
5/97
Reviewer/Inspector Namea-.,�_-'�-
A G+,aa.. ,�iA
Reviewer/Inspector Signature: Xft" - x 4 Date: 10 hAI47

Site Requires Immediate Attention:
Facility No_') I
DLVISION OF ENVIRONMENTAL MANAGEMENT
ANUYIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE'
:'�.3 1996
Time: f�
Farm Name/Owner. C.
Mailing Address:
County: l ?� P I ox)
Intem-ator- " (_<1Y LQJ
On Site Representative:
Phone:
Physical Address/Location: AI U
Type of Operation: Swine
Design Capacity:
Poultry _ Cattle
Number of Animals on Site:
M
244f- 4-e& 7
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: Longitude: 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) or No :; - Actual Freeboard: Z Ft.-C Inches
Was any seepage observed from the laeoon(s)? Yes ordpWas any erosion observed? Yes AD
Is adequate land available for spray? Yes oig Is the cover crop adequate? Yes oi®
Crop(s) being utilized: l' )^ -�A ck
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? el or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(9)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or�
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orC9 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)? .rNo
e.
Additional Comments:
of F
Inspector Narfie Signature
cc: Facility Assessment Unit Use .attachments if Needed.

•
E.-
Site -Requires Immediate Attention:'_1Q
Facility No.�+ 8'L
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �c' a 1995
Time:
Farm Name/Owner:
MailinggAAdd�ress: c7 . c � '1 Q cz ,, ((e Q•(� 2T {'l
County: U p� t
Integrator: d D i (S Phone:
� �KM
On Site Representative: .C y� t/� os` fc L Phone:
Physical Address/Location: �! _1-4,,1. /(/ .40,Ov /- i MILO) a.nr
((p
Type of Operation: Swine Poultry — Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �" �' �D Longitude: � ° �Z' -1Y" 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) Yes or No Actual Freeboard: _�a_Ft. 16 Inches
Was any seepage observed from the lago n(s)? Yes or� Was any erosion observed? Yes or�
Is adequate land available for spray or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: i
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(2�r No
100 Feet from Wells? ?O or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or;(N�0_
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or 1�
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(o 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
Signature
�d
cc: Facility Assessment Unit
Use Attachments if Needed.

•
•
Site Requires Immediate Attention:^ f
Facility No. Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. /o/a 7 , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integrator. d17A
On Site Representative:
Physical Address/Locat
Type of Operation: Swine ✓ Poultry
Cattle
Design Capacity: _J S_60 Number of Animals on Site:
DEM Certification Number: ACE DEMlCLerrtification Number: ACNEW
Latitude: Longitude: 77 /� 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 ag>oon(s)?
r No Actual Freeboard:, ^ )- Ft. Inches
Was any seepage observed from the Yes No Was any erosion observed? Yes
Is adequate land available for spray? Yes o No Is the cover crop adequate? Yes CO
Crop(s) being utilized: ✓ /V (W&tt VCWF1✓ - f i t5'
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes o No
100 Feet from Wells? Yes or No l)n/k.
Is the animal waste stockpiled within 100 Feet. of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 0
If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific apreage with cover crop)? Yes or No
Additional Comments: /V 61,49,12,S Z t�Y U�(l� �ME%✓ /i[/5(//� Ic s�T/I
ol�ld woe 1/se_ swuya, Rga-
//• w '� ....,� .�a„r�,. ri. i. l�o� nf.-. . � �. Jn"r ncli l�'T G>G
Inspector N
cc: Facility Assessment Unit
Use Attachments if Needed.