310245_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
W)

(Type of Visit: 0 Com ce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: (�./�� Arrival Time: ® Departure Time: (I County:
Farm Name: if t 6 �V✓ %11 P-no s' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
0.q ✓ i
Q
t 1.5 40 I ✓
Certified Operator: J�rh
vy
D ,
L I S 4-6^,"
Back-up Operator:
Location of Farm:
Latitude:
Phone: _
Integrator: m IJ S.
Certification Number: _
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to sh
Z
)-17
Dai Heifer
Farrow to an
Farrow to Feeder
Farrow to Finish
I) . P,ou►t .
Layers
Design
Ca -aci_
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I jBeefBroodCow
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes No ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ NA ❑ 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 [:]No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: G Date of Ins ection:
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?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
�[
Observed Freeboard (in): 35-
_
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
Structure 5
No NA ❑ NE
No ❑ NA ❑ NE
Structure 6
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments rreatt, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo 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 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): /0 , m q d R / r-? 01-, 4 ; rn 0 ✓eKS
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yese[:]
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N Rainfall Inspections fudge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes e ❑ 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: Z I - Date of Inspection: iJ
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ YesVNo
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
51<0❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss 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_4: Explain any VE" answers{and/or auyadditional recommehdatitihs:or;any.other comments '
Use drawings of facility to better explain situations (use additional pages as necessary).
o►d 2�-�
SIUd5esu�✓c7 11-2.5---12 IV L4
pr �.6n
Reviewer/Inspector Name:
Reviewer/Inspector Signature: l3 (it STD �i'tJ iZ�
Phone: i 1 9 7W 7 ZVD
Page 3 of 3
Date: -7 7
21412015

Inspection U Operation
for Visit: Q Routine
Referral
Other U Denied
Date of Visit: 1 11-/ f y //Ib Arrival Time: 7 s Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: j Title:
Onsite Representative: Oa—, L (� / S T� /n
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Region:
Certification Number: z-7 f 7,0
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle CapacityPop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
eeder to Finish
Farrow to Wean
'Lrt-
D . P,oultr.
Layers
Design
Ca aci
C•ucrent
P,o ,
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
TurkeyPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑j o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
❑ Yes I' �o- ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page I of 3 21412015 Continued

IFaciUty Number: jDate of Inspection: 12
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,--��
2,110 ❑ 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): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z17No ❑ 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
EjNo ❑ 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
EfNo ❑ 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
❑ A'o ❑ 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
En No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑'lqo— ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a<o❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNo ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
. No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No . ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: S31 V 37 Date of Inspection: /
24•Did the facility fail to calibrate waste application equipment as required by the pemri[? ❑ Yes . ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Nor ❑ NA ❑ NE
the appropriate box(es) below. '
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
❑ No
F3 A
❑ NE
Otherlssues
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
ZNo
❑ 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
do
❑ 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 Q No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? [:]Yes [,—,I,<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesV
❑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).
w770 ZI6�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
__L
Phone: DO W1 730 Y
Date:
21412014

Type of Visit: Com nce Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: Q r
Departure Time: 2.4 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: 17 I p
la
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Galt Capacity -Pop.
Dairy Cow
can to Feeder
I
INon-LayeT
Dairy Calf
Feeder to Finish
O -2-600
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dtpr P,ou►tr. +
Layers
Design
Ca acit +
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turke s
TurkeyPouets
Other
Beef Brood Cow
Other
Other
Discharees'and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �lo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ErNo ❑ 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): T t r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
IdJ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Io ❑ 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
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EyNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej No
❑ Yes
No
❑ Yes
/ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[E[�No
❑ NA
❑ NE
❑ Yes
�t�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ej Nc ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement? If yes, check the appropriate box below es o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 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 [!�<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Z I Date of Inspection: ( S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes [�J No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej 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
[DI�A
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ][5N_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 0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ONo
❑ 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
[] o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[7� o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FNo
❑ 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).
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C (9 74 & 730y
Date: �(3 /
2141201 S

(Type of Visit: O Copipliance Inspection U Operation Review (� Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: riq 1-1 1q, Arrival Time: E74—i—L-7 Departure Time: County: A) e T Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: /AVt l 2 E�STn�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Integrator:
Certification Number: 1 -79 70
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle CapacityPop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
D Heifer
Farrow to Wean
Design
ur en
Dry Cow
Farrow to Feeder
Dr. P,oul
Ca SO +
P,o
Non -Dairy
Farrow to Finish
ILayers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
El Other
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
PIo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

[Facility Number: Date of Inspection: 11 17
Waste Collection & Treatment
4. Isstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 61✓
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 VfNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CZNo ❑ 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 C3/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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?
❑Yes ,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes u1 0
❑ 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 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
�o
❑ 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 YNo ❑ NA [:]NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �(1J No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
QI./o
❑ 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
wo
77''
❑ 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
a4o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,,�,,���
Vo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ NA
❑ NE
Page 3 of 3
J
214/1r014 -

I ypc U...nn: lU a.Umpuancc Impecuuu v vperauun IserIew V JLf Uelare avaruanon l.J icenmcat Assrsrance I
Reason for Visit: grRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,L Arrival Time: .� Departure Time: County: OJj► iy�
Farm Name: Da,, ZA F1OS� nW1yV % Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: —sAyN\t�s p . tls �ov�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region: V4
Integrator: n
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
C•unrent
Pop.
Design Current
Cattle Capacity 0.
Pop.
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry P,pultr.
Layers
Design
Ga aci
Current
P,o
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
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 ;Zj'No ❑ NA ❑ NE
❑ Yes [—]No
[:]Yes [—]No
❑ Yes [:]No
[—]Yes VTNo
❑ Yes 2rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: 111 - Date of Inspection: 1
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: �A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): n
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z[No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[?fNo
❑ 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
—No
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
Vr
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ZfNo
❑ 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?
❑ Yes
qqq
0� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RI No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Vf No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vr No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pa'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
V No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
PrNo
❑ 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 [Z No
if❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o No
[:]Yes [;a No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑NE
Page 2 of 3 21412077 Continued

Facili Number. Date of Inspection: �)
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [-]Yes WrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ?I No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ONo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes �Z No ❑ NA ❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
pn No
❑ NA
❑ NE
❑ Yes
wr No
❑ NA
❑ NE
❑ 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: Ov52' 9 u - azo
� f
V►� Date: { `- DO-
2/4/2011

for Visit: 00 Routine
Referral
O Other O Denied Access
Date of Visit: Arrival Time:© Departure Time: County:
Farm Name:
-
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: \\ ('LLV I',
Certified Operator.
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
AfY9
Certification Number:
Certification Number:
Longitude:
Region:
►IK
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
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
/4) N6
D . + P,oul
Layers
Design
Ga aci +
C•unrent
P,o
Da' Heifer
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 XNo ❑ 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

Facility Number: jDate of Ins ection: 6
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: L%C01V
Spillway?:
Designed Freeboard (in): _0 1 5
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? ���`���"`""""tttt
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
, 1 ndow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): u56-1
13. Soil Type(s): LE
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?
Reauired 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 [D Design 0 Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes A!!!No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Ye 0
No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ] Yes Tl lJ No
❑ Waste Application ❑� Weekly Freeboard e❑ Waste Analysis 0 Soil Analysis ❑)Waste Trans`fers
e❑ Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections i❑ Monthly and 1" Rainfall Inspect' ns
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 ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
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 to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
y00Y""""j"'
❑ Yes I ](I No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T�
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 00 No ❑ NA ❑ NE
'"iiii"''
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes k] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes KNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes KNo ❑ 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).
no
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9�y �`itOa3�
Date:
214,12011

Type of Visit: Acompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ► Arrival Time: ® Departure Time: County: e Llit/
Farm Name: G LS Tolq (—_1%LA/l S Owner Email:
Owner Name: �iqU 1 c_) ELS -xw Phone:
Mailing Address: �ai J I-Awy50 LA_)A ACE,1Yy
C o+0(oii'3g7p
Physical Address:
Facility Contact:
Title:
Phone:
Region:
OnsiteRepresentatiive:
� A U
LS,707
Inte rator:
Certified Operator:
A r�n� g 1)
, r L g TO /f
i
Certification Number:
*q c `�
—1 y 7 Q
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine '00Capacity
Wean to sh
Design Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
Da Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
5 $
DairyHeifer
Farrow to can
Farrow to Feeder
Farrow to Finish
Dr P,oulh.
Layers
ign
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I lBeefBroodCow
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 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
]
IA I No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FacilityNumber: �l Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes "''tttt❑�"'' No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: n
Designed Freeboard (in): �'1 • �j
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.) 0
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? 7770
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 IX I 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 y�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I I No ❑ NA ❑ NE
0
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s): e*ZLRf !SC-1
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?
Reunited 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.
QWUP ❑Checklists ODesign ❑t Maps ❑ Lease Agreements
❑ Yes
No
❑ NA
❑ NE
❑ Yes
} No
❑ NA
❑ NE
❑ Yes
7I77}ll 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 g] No
❑ Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ �aste Sets
Q Rainfall Q Stocking 0 Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
Q Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I yA No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes "`b 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No [(NA ❑ NE
❑ Yes 'M No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 14 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? ❑ Yes9 No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments �,q
Use drawings of facility to better explain situations (use additional oases as necessary).
ta. A.
!'Ac,taaA i �ax� l�u�
Qo�l'r �Ei 'II
�6 t i
Sall, S A�P�
Nor �, SofAc- �
Rv,TU GC-T �R6ocvv DowN �rTrcr ww2F �v�C To Ntnf(.R.ICANE S[hSo�t/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /1
21412011

(Type of Visit 39jCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
rol
Date of Visit: '--HMu Arrival Time: ® Departure Time: County: I N Region:
Farm Name: C S7UN �(A—Cz M S Owner Email:
Owner Name: �p Cl STUN Phone: 9iaa�s—as�S�
Mailing Address:
Physical Address:
Facility Contact:
Title:
/Ve Q? Clt9(o-_49_48
Onsite Representative: S
Certified Operator: �mES
i�1�
�(^l..S%O%V
Integgrraattoorr]:
Operator
Y� LS �6J�
Back-up Operator:
Phone No:
,Certification Number: Iq_4,
Back-up Certification Number:
Location of Farm: Latitude: [� o = [� « Longitude: Q o Q' Q
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 YNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Jw
❑ NA
ElNE
❑ Yes
11
In No
❑ NA
❑ NE
12128104 Continued

Facility Number: ( — Date of Inspection
'Waste 'Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �%o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
�1/
Identifier: ,
Spillway?:
Designed Freeboard (in): 9; 5
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D�No [I NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste °Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ANo ❑ NA ❑ NE
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) S (:f, Qeq-(_
13.
Soil type(s) Aw
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JxNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P[No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other, comments. `
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I AAIOA.: ' (` 65, : _ Phone: -f l o
Reviewer/Inspector Signature: a;7p
Date: _ yal % / i
1 -1 2

Facility Number: 3 —aC/ Date of Inspection / �Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes IjI,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 ❑ Checklists 0 Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes *o
ElNA
[INE
ElWaste Application ElWeekly Freeboard ❑ Waste Analysis 0 Soil Analysis El Waste Transfers El A#ual Certification
0 Rainfall 0 Stocking Q Crop Yield El 120 Minute Inspections 0 Monthly and V
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
,,,///
El Yes pp No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes `�� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes iXNo
❑ 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?
El Yes 4No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes �'*No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
Ix No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes _U No ❑ NA ❑ NE
Additional Comments and/or Drawings:
UeqR7 and b(AE
w a.
Slob 1 .�
Page 3 of 3 12128104

IType of Visit O� Compliance 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: IiD Arrival Time: ® Departure Time: County: Region:
Farm Name: F_:(-(:ZTOTI RqQ-(Y1S Owner Email: n
Owner Name: �AVIn Q- LSTCIr/C 1 , Phone:
n91O-a85 �S&a
Mailing Address: Sud `-�
Physical Address:
Facility Contact: Title:
Onsite Representative: �p l] t� G"T-C)N
Certified Operator: AmCS EL-S-)CN
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 1-4 9�40
Back-up Certification Number:
Latitude: n o n' n„ Longitude: ' I o
a
-=Design,-„ Current...'. Design Current t `` - ^Design QurEenfl
Swore Capacity Population We[ Pomtq Capacity Population - .Cattle,p �� „Capacity Po la 'a
.. _ _
-
❑ Wean to Finish
❑ Laver
I
I
❑ Dairy Cow
.-�
❑ Wean to Feeder
;? ❑ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish5Q
1
D Poult `
' ��`' �""'"""
�'�''.,,&-q
'"`'
" ''
El Dairy Heifer
❑ Farrow to Wean
• ❑ Dry Cow
ElFarrow to Feeder
❑to Finish
El Gilts
❑ Non -Dairy
❑ LaersFarrow
�= El Beef Stocker
T] Non -Layers
El Beef Feeder
❑Boars
Other • • '* _�
❑Pullets
❑ Beef Brood Cow
❑ Turkeys
E] Turkey Poults
Number of Structures:
❑ Other I J. ❑ 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?
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3/ -d + Date of Inspection 1 /�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ANo
[INA
ElNE
a. If yes, is waste level into the structural freeboard?
ElYes
❑No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: L4460 N
Spillway?:
Designed Freeboard (in): S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C�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
a" C No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IM No
❑ NA
[INE
(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
, {{y
�I 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
El NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El 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) e>
f> .i Gl
13.
Soil type(s) 6inh
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
jo No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V0,No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (Peter to question•#)- "Explain any -YES answers and/or any recommendations or any other comments ;n �S
..P
Use�drawin s of facili to betterex lamsitaati'ans useaddrtronal a es astnec`essa ` - ..-�" " •r
4ni
a
Reviewer/Inspector Name Phone: d l9 -
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: I —cgLiS I Date of Inspection / O
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 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑)kaste Transfers ❑ /nnual Certification
❑ Rainfall G Stocking El Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
W'H .
�-l3e�o�► l.8
Sot t_ SA' Cat_CC i E S `t SEJv1 J A4
❑ Yes
No
❑ NA
[I NE
❑ Yes
` y�l No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
)ANo
❑ NA
❑ NE
El Yes
V0 No
❑ NA
❑ NE
❑ Yes ,QNo ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
WAHRzi

/� Division of Water Quality
Facility Number 3 o/y 5 Division of Soil and Water Conservation
— — _ D Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 11 cl. ao 1 Departure Time: County:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: ` F�* Title:
OnsiteRepresentative: _iAoKs
`
Certified Operator: l JAM G S t- S f 0/✓
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Region:
Operator Certification Number: 1 _494<2�
Back-up Certification Number:
Latitude: [ o = ' = Longitude: [� o =' =
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes V No ❑ NA ❑ NE
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
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
DdNo
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

Facility Nhmber:31 -�4S
Date of Inspection D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): / 9. 5
Observed Freeboard (in): CQR
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltreat, 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 ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
A No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
6No
❑ 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.
Croptype(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?
❑ Yes
A No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J] No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
QQ No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�
Reviewer/Inspector Name F (JA /%i/GS -] Phone: 9/0 (o- 39_A
Reviewer/Inspector Signature: Date:
Pare 2 of 122RI04 Continued

Facility Number. — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
94No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
%No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
-gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ 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
allo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ZNo
❑ NA
❑ NE
Page 3 of 3 12128104

l/I V Division of Water Quality
Number 3� �T� 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit QjCo pliance Inspection O Operation Review O Structure Evaluation (';� Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 �_ Arrival Time: Departure Time: County: DOPL114 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 4%km E t-STOtJ
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Title:
Latitude:
Owner Email:
Phone:
c
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=1 Longitude: =v=' [�"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
E]Dairy Cow
E]Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes u No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
❑ NE
❑ Yes
❑ No
Yes
ElE
ERNo
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

Facility Number: ,3 — a, S 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: (_14666.4
Spillway?:
Designed Freeboard (in): 1 rh S
Observed Freeboard (in): 3u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes ZNo ❑ 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
ONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
N
N
Eo
❑ 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
.
21 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,(/
L� No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CNo
❑ NA ❑ NE
❑ Excessive Pending ❑ 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 Drill ❑ 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?
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? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
I
El NA
❑ NE
O No
❑ NA
❑ NE
Id No ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
/S.) l.WEE0 CoAlMoL A1EEoE0 Fog F.ZECD,
,2ECoNIMEko Our 9E UPDAI(Q P60- uOF E*)D3.tj&, W_rN00W
Reviewer/inspector Name
Reviewer/Inspector Signature:
Phone: U
Date: _
12128104

,Facility Number: 3 I —A4S Date of Inspection 2 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
❑ 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 ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections []
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O/NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
,BNo
I� No
"IA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErNo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
EN
2 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
,2"o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
/
ONo
❑ 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
0Nf
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
LI No
❑ NA
❑ NE
Comments and/or
12128104

(� Division of Water Quality
Facility Number S 0 Division of Soil and Water Conservation
---------- 0Other Agency
Type of Visit pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: is till Arrival Time: 83O Departure Time: County: 4N PLZ:tJ Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 0AU-1b C' -ST00 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' a Longitude: [� o
Design Current
Design Current
a f
Design Current -.
Swine Capacity Population
Wet Poultry- Capacity Population
Cattle
Capacity=Populatton;"
".
❑ Wean to Finish
❑ Laver
❑ Dairy Cow
❑ Wean to Feeder
�:- ❑ Non -Layer
Dairy Calf
® Feeder to Finish 2.980 �? L
❑ Dairy Heifer
- ❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Da.
° El Farrow to Finish
�:. ❑ La ers
El Beef Stocker
[I Gilts
El Non -Layers
El Feeder
El Boars
- ❑ Pullets ��
Brood Co
-- -- — — - - - -
❑ Turkeys
(❑Beef
Other ,.
❑ Turkey Poults
-
❑ Other I
j. ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
El NE
❑ Yes
❑I N9
El Yes
CJ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [2 o ❑ NA ❑ NE
12128104 Continued

Facility :Number. 3I — 4S Date of Inspection /6 za ts4
Waste Collection & Treatment
-- //
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
El 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: /A600p
Spillway?:
Designed Freeboard (in): q S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EI No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[I Yes
,._/
O 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? El Yes L��Jo ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes E,'NNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) El"
9. Does any part of the waste management system other than the waste structures require ElU Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �{/_
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L3No ❑ 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) gCV) S co
13. Soil type(s) A o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
TNo
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
E1No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
ET No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
WNo
❑ 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):
13E SUM-4, to GcT NELJ WUP QEFOa6 AP.��it�G.
at.) WUP NAS l3f0_MV0A otA' TCU SCM APPt.=cATj�n�s a�J Oc.r voSS fio S G o,
Reviewer/InspectorName �Totin) 60.1 ( Phone:IAipl7�l6
Reviewer/Inspector Signature: ni �q a ,�1j1tw.9�C Date:
Page 2 of 12/28/04 Continued

Facility Number: 31 — asls Date of Inspection to zn oli
�Reauired 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✓J No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
/
21.
Doe ecord keeping need improvement? If yes, check the appropriate box below.
LJ Yes
❑ No
El NA
❑ NE
LI Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,,,��,,,
O/j N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,-71;0
l JfNN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C'J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EfNo
❑ NA
❑ 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 ,6d No El NA El NE
El Yes ErNNo ❑ NA ❑ NE
❑ Yes (_J No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes 'LI �No
❑ Yes EfNo
❑ NA ❑ NE
❑ NA ❑ NE
Page 3 of 3 12128104

IType of Visit 00 [Icompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: Z pJ Arrival Time: Departure Time: V . / ounty:
Farm Name: �J'�O/� // /%/n S Owner Email:
Owner Name: �/%!�<� �G'�%�(7/J Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �%dZlJ`�D/✓
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =0 =. =" Longitude: =o =, =„
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish JE1 Laver
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish 12,0130
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
El Pullers
❑ Turke s
El To Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
El Dairy Calf
El Dairy Heifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 0 No
❑ NA
❑ NE
❑ Yes ! Q No
❑ NA
❑ NE
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn 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
Slru ture l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in): 2-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �INo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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?
❑ Yes
i No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![] Yes
�(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t2rNo
❑ NA
❑ NE
y /fily� �9-caaJ s�szo�✓ lj���o, GPI cu��/ w��,,, Zi/u./ iC�.-Cates ��
/AGE49
A- 2s..-2,
,nn70XA9
l/i/�Gzi✓ �ZG 4. G�/i¢t� /
I Reviewer/Inspector Name 4.ifi571L �j j F' ,� Phone: YfV
4�ilrti ...;.
Reviewer/Inspector Signature: Date: O
Continued

Facility Number: — Date of Inspection
Required Records & Documents ,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ?{ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes oNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [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 ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
�dNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
El Yes
�No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
)2(NE
❑ Yes No El NA El NE
❑ Yes/,C1 dNo ❑ NA ❑ NE
❑ Yes
/V---
El NA
El NE
El Yes
,,,,,,,,,tttN"""o
110
❑ NA
❑ NE
❑ Yes
No
El NA
El NE
❑ Yes
eNo
❑ NA
❑ NE
Additional Comments and/or Drawings::
�_/) rA%10 XPr7-1j"g51kC
_� ro� Y�c�inP u� L
/1�N �z an15 ;/7X o�ou r� 8� TO P
12/28/04

Type of Visit /- Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit x Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: fa 9 ON Time: 12.a0
10 Not Operational 0 Below Threshold
Permitted)dCertified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName: _ ...... 4L�._.rll..f...._.__._......____....__......._.__..._._ County:.._.
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
_...._._..._.--.__.�JPhone No: _.___._._...._..__.._. __.........
Integrator:__.1_:.1.N.A._...._.....__._.._....____._..--
Operator Certification Number: .............................. . .... . ....
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F---J• =, =" Longitude =• =1 =«
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ea/No
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 gaUmin?
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: ...... ....... I ................. ... _.................... ---- ...................... -...... __..................
Freeboard (inches): z
12112103
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes❑ No
❑ Yes 0<0
❑ Yes ❑ No
❑ Yes
Structure 6
Continued

Facility Number: — 2,yr Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes aldo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
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? ❑ Yes p N
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Io
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 3E2mV0A (�I) SGb
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes — NNoo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes FN
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Y s
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes 2 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 1;1
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,a�s14
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Q o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Field Copy ❑ Final Notes
15) Weep Cot-AUL NECESSARY _W BERw%VDA FZfLb. ovperL ZAS9a-sG.
Ssres��.
35) X KR-1) S-roC=004) C;"e) R.AXWFALL,/ 1' IZAzW 11-0 A4T-&JUr(- ALL nlEC b no d6
ittiWS�E�R�D 7o IJ(W FaZjvVS. ALL. 'RfCo J QW(rfr.
Kcw col'Y of AMIJUAL, C,E(t-T, W1 PCOMUS, was 9WT.
Reviewer/Inspector Name _
Reviewer/Inspector Signature:
Date:
l.0/{ffIf4CO

Facility Number: 3
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Doe record keeping for DES required fo need impro ement? If yes, check the appropriate box below.
p Stocking Form Crop Yield Form Rainfall [+'Inspection After 1" Rain
120 Minute Inspections ❑ Annual Certification Form
❑ Yes ZNol
❑ Yes
❑ Yes No
❑ Yes 0 NO
❑ Yes 20,Yes 1
❑ Yes ENO
❑ Yes LrN
[]Yes L1 No
Yes
❑ Yes
❑ Yes
❑ Yes
❑Ys
Yes
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
❑N
VRN N
V
ld No
❑ No
12112103

Type of Visit 95 Compliance Inspection O Operation Review , �O Lagoon Evaluation
Reason for Visit o Routine O Complaint 0 Follow up Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: �
Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name:
Owner Name: ff2 'Cl_ S?fJ/✓
Mailing Address:
Facility Contact: F Title:
Onsite Representative; /Jgn ✓6 5ns) ..
Certified Operator:
Location of Farm:
Time:
Date Last Operate r Above Threshold: _
County:!/>°Lzi l
Phone No:
Phone No:
Integrator:
Operator Certification Number:
(,Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0' 0" Longitude 0' 0` 0 u
Farrow to Wean
Other
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?
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:
Freeboard (inches): G �'
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
VrNo
❑ Yes
grNo
❑ Yes
XNo
Structure 6
Continued

Facility Number: 31 Date of Inspection Q�
5. 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 4fi 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 Aoolication
❑ Yes X,No ,(
❑ Yes ��J/NO
❑ Yes /[2 No
❑ Yes P No
❑ Yes )dNo
10.
11.
12.
Are there any buffers that need maintenance/improvement? -
Is there evidence of over applicati n� ❑ Excessive Ponding ❑ PAN Hydraulic Overload
Crop type C Z fi�iQ—iE'F
❑ Yes ANo
El Yes (XNo
13.
_K
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑Yes
ANo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
�No
b) Does the facility need a wettable acre determination?
❑Yes
XNo
c) This facility is pended for a wettable acre determination?
❑ Yes
gNo
15.
Does the receiving crop need improvement?
❑ Yes
ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records & Documents
//
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
)zNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21.
Did the facility fail to have a actively certified operator in charge?
El Yes
,,XNo
//Ip No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
/
(ie/ discharge, freeboard problems, over application)
❑ Yes
/ZNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
V'No
VINO
24.
Does facility require a follow-up visit by same agency?
El Yes
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
ONo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gomments,(reterto question it) E`x'plamsany Y ES answers and/or any.. recommendations or aoy,bther comments:
drawings of facdity�to better explain situations (use additional pages a +necessary) ❑Final
.IJse Notes
l . , ,. �r Field Copy
,<Fl� O <Q� P E�ZP ROLPn/�O G'D o�, �% •�
&'
,�/ ef'K
G(iOOq No��Q /C�GO/ c_ 40 Z, 5z e /yifCG 6 p 24e"ga i.
Ol/PGz�% u�47/ /� D25TRZG> /�BB�!> �/�ooA) D/ S�
i�A7 2,y"70i /9Q/� Zs �E q�zv o S� so
(.f//li�Gz9-�✓Cf � SP.EC7?-ram �i� 8�3�0/.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 2
OSIO3101 Continued

Facility Number: —2 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fm(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 , "STo
❑ Yes No
❑ Yes r/I[.Q�No
❑ Yes �No
❑ Yes ,,V���J///No
❑ Yes /�Q No
❑ Yes ❑ No
Additional Comments and/or Drawings: , 4k37
-
�p�lS�oE.e z�G NC ulliFz ��►n1F 17s>ofz y
�A5�/J �,✓ hte sL/F7�P� z�l/�y-Tzon�,
jJ �pnl7z�/C�i� 7 41,04 S14 Pell
�JrPR�FLo ���o �o,e C✓F_ �,os �i�//J �R S �p4�/J
J %•� L z�� �,9� •�� rQE�o�,nJEA/oEp �� ZUo �
SOZL �P�PD�T
�Ecflgos, �Fi�/I) Z 7 •QuyQ�s ,P�coe,os sae 3
/%lyzAo, � Z�✓� o-
arr�^/fR /�/J
o fTe= ( M,00
(COR,J Z,j �2Fi�v Noel) 7o & 45-IF 41W S9rd f
05103101

(Type of Visit Compliance Inspection O Operation Review O lagoon Evaluation I
Reason for Visit oRoutine O Complaint, O Follow up O Emergency Notification O Other ❑ Denied Access
Fee itity Number 3 t(S Date of Visit: S 3 B Time: e}+30
Q Not Operational C Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified El Registered Date Last Operated or Above Threshold:.._.__
Farm Name: ........97islo." .�r.^.. § County: .2)/Q it
............... v _....._._..._ ....._.._ __
OwnerName:........ 1_1r:. .....� 5 ��`1................................................................ Phone No: ................. _..................
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ................... __...
OnsiteRepresentative:_,D...Lvi ��S�oh........................................................ Integrator: frPn�lut"1:_S'!�tQ4:.: .._._. ........ d........................ ............. ......._..
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =1 =1
Design Current
Capacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number -of i
Design .Current - Design
Capacity --Population Cattle Capacitv.�
❑ Other -
Total Design Capacity
Total SSLW I -
-. _�❑ Subsurface Drains Present JJ❑ Lagoon Area J❑ 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?
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
r: Identifie............._L........... .... ................................................................
Freeboard (inches): :Z!5
5/00
❑Yes ONo
❑ Yes _j2rNo
❑ Yes 2rNo
-h /,I
❑ Yes EfNo
❑ Yes Zj No
❑ YesAET-No
❑ Yes_A!fNo
Structure 6
Continued on back

Facility Number: 3 — 2y5 Date of Inspection 3 O /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E!rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes EfNo
(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 lie No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes E!(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JdNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes jzfNo
11. Is there evidence of over application?`' ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type Ge✓'r 1,Vdcl, flay , '5 "01 6r1k%n
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO .
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
Yes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes_zNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ENO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes-)ZfNo
(id WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes I MO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PINO
iQ Yiblati¢njs;ot defjcpencie w$re pofe¢• it(triilg thps;visit; • yoit will •i-ec�iye 4t� fustMgr • ; • ; s
corresnorideitce: about this visit: :::::::::: :
Comments (refer to question #) _ Explain any YES answers and/or,any reeommendetions or -any other cotnmenls.
5--T-he dellv(J (4 S44rtt i'fgoec{ �,, -the m',dAIe of j12e eld��Ffo��s heed
+o be "n4',ived 49 be-He,-e-q4bl;s� s (xrmvda glortiq des od e/d•
Lr,�P should be Al�plled 10 AeIA.
N o�ef Mr. E-Was, 41tci4 e, we-E z b/e aloes o4e7e✓'r, vIG ( ovt i?k.s 6ee'j
ee" Ple4eo�. 4e 90 alheciLi Q 1ci e aA,4 nue w.4t, car ehf recoeA
Sc11er,e 4h,-,,v16e'r%'vdA SeA.SDvI -In4 %1h USihs •{-he
�cvt-I-►� _
V
Reviewer/InspectorName-iO>lltn/s�i:�j-}�I.rS—V
Reviewer/Inspector Signature: " Date R 3 D I 5/00

Facility (Number. T/ —2 q S Date of Inspection 8 3 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,0"No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes/QNo
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 ❑ 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_,[TNo
31. Do the animals feed storage bins fail to have appropriate cover? []Yes Jallo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an orDrawings: -
e0h+) Lve+�ble 'eras oK S)Orap q"d �;eldS tv;4� 4e beginh;-,,
•
/records
&'-(-/4t Swtal19�Aiti CNOr 41Ii.I Co�1"� SeciJaI.
The kgeo.,,Oks:i5h Shows Jt ,t - ab Ie4j Zq, o( �,eebati2'i S�oalGi
60 keJ94 i-I (a900h, C6LASu tV -+�1t ot 4ee6y t-ca l S�e t i al i f-l- �bou f
I1
�r IJ —AP G�P�'Gr Mi✓iP i-F 7�t,r 6Ah t,, AL�J Ur�eG✓!.
1 „ ,I
Ove.-Al) 1-(11e Y11ALLLi �l1 `, qrW re CoI-dS .1pp , well
2q, 12Pa1-PA(J+ Yla�l't" TD .5 S4a 'k ;✓1-khe.
5/00

Division of Water Qualitye _ -
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: GU 'time: Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted Q Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .......................
FarmName: .......L �!..� ......O.X................................................................... County:.... - \..................................................
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
Mailing .Address:
..................................................................................................................... ................................................................
Onsite Representative: ........................................................._................................. Integrator:
..''..........✓ JJ
.................... .
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
[]Swine []Poultry []Cattle []Horse Latitude �• �° �" Longitude �• �' �"
Design Current
Swine Camcity Ponulation
❑ Wean to Feeder
eederto Finish
$6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry_ Capacity Po ulation Cattle Ca aci Po ulation
❑ Layer I I ID Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
!VNo
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. li' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
CKNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
[XNo
Structurre I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5100
Continued
on back

Facility PjumbDate of Inspection 7/21/2000
Printed on:
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
'tS(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
NJ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
KYes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
X Yes
❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
NfNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
XNo
12.
Crop type 2s 1 Sy
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
NfNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
I$ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended fora wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
5r1yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
3<No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes tE(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.) i'wYes j tjTNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes F8rNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [CXNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Cg,�Io
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes cg�qo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes CKivo
24. Does facility require a follow-up visit by same agency? ❑ Yes P�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
tVti.yiblati#ds;o d0fi:66nd-NWreit9t;e#-d(Wingtbjs;vjsit'-Ybit;will_i•ebeivetigfuithgr•; ;
cories otideike: abouf this visit: :: :
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):
.a t`65cY" �`�+ �( (��� • � l vt cry \�` Q
Reviewer/Inspector Name e Ak;-' \� �\ qk 96 39 S ''
Reviewer/Inspector Signature: \ iz , Date:
5100

Facilit3 Nomber: S — Date of Inspection Oa Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below
P(Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
[J 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
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
Yes
or broken fan blade(s), inoperable shutters, etc.)
❑
J�JNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
OrNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
Additional omments an orDrawings:
.eL
►�-ew2C ever-�rr ``a `3 we-e�s `� c�,�t-\\�\ c�� �it� t,..�'��-eS��1�
tg/
LP
J
5100

Division of Soil and Water'Conservation - Operation Rev
- " -
' 0 Division of Soil and Wafer'Conservation - Compliance Inspection
Division of Water Quality - Compliance Inspection
- 3 Other: Agency -. Operation Review - - ` Z.- ' " = - -
Ila Routine 0 Complaint 0 Follow -tip of DWQ inspection 0 FolloN% -up of DSWC review 0 Other
Facility Number 'L Date of Inspection
'time ofinspection Ct7 24 hr. (hh:mm)
Permitted P Certified[30 Conditionally Certified 0 Registered Not O erationaf Date Last Operated:
FarmName: -4v'q/. ui Ikn.........avo............................._....................._ County: Y�................._......_.....................................
Owner Name: ...................._.j121A[2....................:._E!S� ....... Phone No: , TO. A$ .: 2 %
Facility Contact:
Title:
Phone No:
Mailing Address:.........5..t.:iL.I........... �1!V F...._/N.�....-�........�............................ ..............I... 4C.F.:iii.���;..... N.f................................. .!.!'A7.i?.�i........
Onsite Representative: ................lmh).........el.S.61.................................................. Integrator:......
...li..........................................................
b.Certified Operator: ............... Q,jyas........ :..... ........ C..I.56?................................... Operator Certification Number: .... ,(.�97.0.....................
Location of Farm:
Latitude Longitude �• �` �"
,�wme L apacrty roputauon
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons J❑ Subsurface Drains Present JLJ Lagoon Area J❑ Spray Field Area
Holding Ponds / Solid Traps ❑ Nu Liquid Waste Management System
Discharges & Stream Impact.S
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
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 Waters ❑ Waters of the Slate
c. If discharge is observed. what is the estimated flow in cal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
❑ Yes q9 No
❑ Yes [§ No
❑ Yes go No
❑ Yes'
❑ Yes No
❑ Yes No
❑ Yes No
Structure 6
Freeboard (inches): ............ 2'y.-.............
1/6/99 - Continued on back

Facility Number: 3 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, 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'? ❑ Ponding ❑ Nitrogen
12. Crop type
z �
❑ Yes [A No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible 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?
No.violations-or-deficiencies.were noted during tliis visit:. V-ou wilfreceive no further. -.
- pQr respbtidehee' abbot; this :visit .............:... ..:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.: .
❑ Yes j 9 No
[ Yes ❑ No
❑ Yes [A No
❑ Yes ® No
❑ Yes C9 No
❑ Yes 19 No
❑ Yes to No
E Yes ❑ No
%Yes ❑ No
❑ Yes 1P No
❑ Yes M No
® Yes ❑ No
® Yes ❑ No
❑Yes allo
❑ Yes M No
❑Yes [9No
❑ Yes l9 No
❑ Yes ❑ No
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 asnecessnry)ii
Z. C, Uo rs Ou''LbS apv lvn) A-t v4t 0 1664 6e, N�t�� wi .- (.UJN r�
IQ. tl/v.S cW.ver—w;ll �� �'IG e �,x({�,b(� "WAds.(wtttitha;'�ioh un SS rL
�q.• UPar �d"Vt1k 1e0f k( .�a1e�«i t(aM,(~bCL�
_ Air —
of
cc�� Isc ro� e�
te�v6 Ewacnk,b5nkof wve S,o�
Aco r, 5PA^
ReviewerQnspectorName „ 1AAR. K
Reviewer/InspectorSignature: ,f„� Z 4/41 Date: 7/// M 1I/6/99

Facffity Number:._.. _ — Date of Inspection:
Additional Comments and/or Drawings. ,;�,L
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l9• fbnEl -
U%GS�f
Ct �w iy 515 S I`
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brmvdi& rff fi-S
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I
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ReP`:tn.�;ar<re.to•�s d- �`w��p
W P Flc��o�.`� ���rnwl�or� %W4 6� �WJ4 b� 3jyJA`i or o-
�"r.SLO, ccr'irc.T �n,— elc�n.Ory
4/30/97

10 icounne C c.ompiamt 0 rouow-up or uvvtt inspection p rouow-up of u�wt: review 0 vtner
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
Permitted 0 Certified p Conditionally Certified p Registered o[ perationa Date Last Operated:
Farm Name: Elston.F.arms.................................................................................................. County: Duplin WIRO
OwnerName: David ..............................._.... . Elstna......................................................... Phone No: 285-25.80 ...................................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address: 5421.S.Jiwy..5A.......................................................................................1'1'.allace...N.C........................................................... Z8.466 ..............
Onsite Representative: .......................................................................................................... IntegratonDogwitniAEAram ...................................................
Certified Operator:James.D................................ Elston ................................................ Operator Certification Number: 1.7.4.7.0.............................
Location of Farm:
Latitude ®®.. Longitude =• ®' ®:.
!'= >c-Design -- urrent _ ;Design- Current esign _Current
Swine — :Capacity--Popula`ti- Poultry Capacity Population' Cattle , Capacity Population ;
` ❑ can to Feeder 5 ❑ ayer ❑ Dairy _-
® ee er to tuts ❑ Non -Layer ❑ Non -Dairy
❑ arrow to Wean
❑ Farrow to Fee er ❑ er
❑ Farrow to Finish = Total Design -Capacity 2,880
❑ Gilts =_ —
❑ Boars T0t2if_ LW.388,800
Number of Lagoons ,;.� ,; ❑ Subsurface Drams resent ❑ Lagoon Area JE3 Srray ie rea -
' " Holding Ponds / Sohd Traps j0 ❑ o iqui aste anagement ystem ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes 0 No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............19...............................................................................................................................................................................................
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

. Facility Number: 31-245 Date of Inspection
6.
Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
[]Yes
[]No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
p No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
[]No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[:]No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
p No
11.
Is there evidence of over application? ❑ Excessive Ponding p PAN
p Yes
p No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
p No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
❑ Yes
p No
15.
Does the receiving crop need improvement?
p Yes
p No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p 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
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
3 No.viohations-or.deficien'cies.were-n-oted-duringahisvisit.-YYou'will -rereivt nafurther.':':
............................... ............. .......
Ftrxespotidence: abouf this' visit:
freeboard available.
)SW): Vegetative cover is in excellent condition all around dike (Bahai grass cover). No overtopping, dike is in tact No
dations to the grower.
Reviewer/Inspector Name �Greer`MeVrcker,' _ BriawGannon.(DSW).
Reviewer/Inspector Signature: Date:

Lagoon Dike Inspection Report
LL-1
Name of Farm/Facility
( n
}' 1T Sto..
Location of Farm/Facility
P� go r!d S C
G P P z Sa k sR
Owner's Name, Address
v b 1 S`I/0, S y2 l S P-v
Y S
and Telephone Number
Date of Inspection
` Names of Inspectors
{C4AWo
Structural Height, Feet
_ Freeboard, Feet
p
Lagoon Surface Area, Acres
I
�C�e c K Top Width, Feet
/
Upstream Slope,xH:1V
99�c
1 ; / Downstream Slope, x1-I:1V
Embankment Sliding?
/
Yes / No
(Check One, Describe if Yes)
Seepage? Yes ` No-- �,%o 4 1; /tz f' /cfGv
(Check One, Describe if Yes)
1i^er+ ��F4 ulc�/ /nor �S7✓��,�e
Erosion? Yes --,>—,— No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes �— No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes _ X No
Engineering Study Needed? Yes }L No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

�.1�.. :Y�.. �{".3a.. .r`ti� ��::.: ysC�. my .... '.x+?.. a.� ������____. _�...
1
�, �°�'
�� �.�

0 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
Facility Number Date of Inspection L_
Time of Inspection E= 24 ha (hh:mm)
Registered Certified E3 Applied for Permit 13 Permitted Not O erational Date Last Operated:
FarmName:.. ............... ..... County: .........._t':P1!................................. .......................
.......................................................................
Owner Name :............................. ........ Phone No:......................,.t2w Q
FacilityContact: .............................................................................. Title:.............`..................................................... Phhonne�No: .............................................
......
...
Mailing Address:.. � k Q ktA� �kS, Q `66
�....t..(%....................5�.........a�..%...'.............................................A............................................................................
Onsite Representative:..S/w./%14 -.... 1.............................. Integrator:_.._.�1iac�4 �LSid..... ..............._.......
Certified Operator................................................................................................................ Operator Certification Number,.........................................
Location of Farm:
.... ......
.......................................................................................................................................................................................................................................................................... .
Latitude Longitude
F
o
Designurrent `
":Design �; ' urrenf ' _' est n, urcent ;
g
Swine"
-Capacity "Population
,
Poultry :'Capacity Population Cattle Capacity Population
❑ Wean to Feeder
, ❑ Layer ❑Dairy
Feeder to Finish.
Q
❑ ' Non -Layer 11 1 x ❑ Non -Dairy
.�- ❑ Farrow to Wean
-
.r ❑ Farrow to Feeder
❑Other - -
`' ❑ Farrow to Finish
- Total Design Capacity`
[I Gilts.
❑Boars
Total SSLW
Numberof Lagoons ! Holding Ponds
❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
n
(General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
b No
2. Is any discharge observed from any part of the operation?
❑ Yes
EANO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
O 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
ZPt
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
0 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
IS No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
P[No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
D1 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
UNo
7/25/97

Facility Number: -)4
• 8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.Noldine Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:..........n. A/ ........:...................................
Freeboard (ft):.........:.�5 7............................................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(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 Application
14. Is there physical evidence of over application?
(If in excess of WMP, or noff entering waters of the State, notify DWQ)
15. Crop type .....b...............
di
f.........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
p• No violations or deftciencies.were noted during this: visit. You.will receive no ftufber:
correspQudence about this:visit:
❑ Yes
%No
❑ Yes
ErNo
Structure 6
...................................
..........................,..r........
❑ Yes
ey No
❑ Yes
IgNo
XYes
❑ No
❑ Yes
j(No
❑ Yes
NNo
❑ Yes 0 No
❑ Yes C&No
ayes ❑ No
❑ Yes 1XNo
❑ Yes MN0
❑ Yes V1No
(Yes ❑ No
❑ Yes [XNo
❑ Yes iI No
❑ Yes P3 No
sgtl Y It-7r
b� tat r 14 Ve��
I^� , y __. 1 _ L _ 1. i_ n ��_ _ _ \ _ \ ^ _ . 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: � � ( AN_' i_ Date:

afi DSWC Animal Feedlot Operation Review U
® DWO Animal Feedlot Operation Site InspectionMAI
Routine 0 Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
`) Date of Inspection IV i q7
Facility Number 2 1
I Time of Inspection �74hr. (hh:mm)
13 Registered ® Certified 0 Applied for Permit E3 Permitted 0 Not Operational Date Last Operated: ..........................
FarmName:.......... ............. .................................................................... County:....... r..................................................................
OwnerName: ........ ..AA►......EkbA............................................................................... Phone No: ... ............................................,
Facility Contact: ........D.4�.V.icc...... . 6f.0n................................. Title: ........ D.t!ur.......................................... Phone No:..Ck10).2.11._z V..7q........
Mailing Address:... ,?-%. l--I....n1.C...1 ktJ.l�._LSA...... &C }...................................................... L..............`................................ 454o...f........
Onsite Representative: .... 01"J...... tC�S 1....................... ....... ...._............................._. Integrator: .......�i031')Z 6.031')Z� ...................
Certified Operator :........ DAIJ...... fV.IS.6................................................................... Operator Certification Ntmtber,.... 11q_1d...................
Location of Farm:
6.�......4 ..... 4... nt.....
Latitude 0•
Swine
Capacity Population
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude =• =' =<
Design Current - Design ".Current.
Poultry Capacity Population Cattle Capacity Population
❑ Layer 1 ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
=Number of Lagoons/ Holding Ponds, 0 ❑ Subsurface Drains Present 10 Lagoon Area 10 Sprav Field Area I
- ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 52 No
2. Is any discharge observed from any pan 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 1P No
c. If discharge is observed, what is the estimated Flow in _•al/min° IN
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require ®'Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes UNo
7. Did the facility fail to have a certified operator in responsible charge? _ ❑ Yes XNo
7/25/97
Continued on back

Facility Number: 31 — 2�S
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Laeoons,11oldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? "
Structure I
Identifier:
...................................
Freeboard (ft): ............. �.1g...............
Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity otlany of the structures observed?
12. Downy 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 ADolication
❑ Yes 'D No
❑ Yes
® No
Structure 5 Structure
...............................................................
6
.................................................................
- ❑ Yes
'0 No
❑ Yes
10 No
'j,Yes
❑ No
Q Yes ❑ No
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ........ \5e.VvnJa............................. (V A«......i�!.I.t.............................................. �.rScvG....................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW VIP)? 19 Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No -violations or deficiencies were noted during this.visit..You .will receive no further
correspotidence about this:visit:":
answers and/or
. (use additional
❑ Yes 1A No
9 Yes ❑ No
❑ Yes 0 No
® Yes ❑ No
❑ Yes ® No
SYes ❑ No
❑ Yes ( No
EAYes ❑ No
❑ Yes 19 No
•Low a.K-a i.N SprrMeld6 oojj be vtt&crro. C.6rJktt Soils G�a�Fes dar aSsi5"Ce.
(2. Gvos;ot. t:vcGS or` 1,t invw "di A 165oc, <Wd be 6`14d vtk 41 11�j rtsteded. &rl-
oxta-s sGt q msteded
Is, Llkuid (eve 1 tuwoL r tLA 11A Nd th falcon • t
16• vr�ve ``p.�6�' \�\ ,��h" 4t01 dez;t)vwW' tt �xtjfrttro� Ls�ul� be i/m1 wcd sprig
2.2- �2sax �rwul(/ pe• ca_W �Q 0--o-sc tlil i 11 K a�Gax. emel G(.fee�agqtS TDf S1)IYu/ evvis SkNO
)_e uset) �r` rcl en l�alArce Calcv�afimis• U rtbs a. a sus awr� Ic'3 f\ deS, slnou d be ire
2J1 K�,r� %ac 4�0.uf� on CYOA AO 1--W i'npl0.n- D-KCm111tn.L S�('Cvy'tt��h �S�uQ ul%)A c /25/97
Reviewer/Inspector Name '' 'I
Reviewer/Inspector Signature: Kl�__ ,, Al - Date:

0
•
Site Requires Immediate Attention:
Facility No. 1-4jq
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO71SM,
VISITATION RECORD
DATE: 9 1995
Time: 13soso
Farm Nam
Mailing A,
County: _
Integrator.
On Site Representative:
Physical Address/Location:
e5r.
.y
Phone:
Phone:
Type of Operation: nS�w.ine V Poultry _ Cattle
Design Capacity: 4V Ao r®P Number of Animals on Site:
DEM Certification �Number: ACE DEM'C/eertification Number: ACNEW
Latitude: ° Y� ' U� Longitude: �' �' -3&" Elevation: Feet
Does the Animal Waste Lagoon have(approximately 1 Foot + 7 inches)6
Was any seepage observed from the 1.
Is adequate land available fo ray
Crop(s) being utilized: D
Circle Yes or No
.cient freeboard of 1 Foot + 25 year 24 ho storm event
No Accrual Freeboard:^�Ft. Inches
n(s)? Yes orWas any erosion observed? Yes No
No Is e cover crop adequate?�r No
w e.. nw
Does the facility meet SCS minimum setback criteria? 200 Feet from
100 Feet from
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?
Yr No
or No
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 o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on s
Additional Comments:
/00 g rtt,
with cover crop)? Yes or No
cc: Facility Assessment Unit Use Attachments if Needed.