310397_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

9
Type of Visit: VCo�¢liance Inspection O Operation Review Q 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: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: r' I C 1164 i �IO�(, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: 10,00307
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
—I n Current
D , P,oul , Ca a P,o
I Lavers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[% No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [no ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): U Z 33
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
reat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
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 OfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
0 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 [],tao NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ 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 ®'Klo - ❑ 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: - 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 E rNo ❑ 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 ❑ NSA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 01 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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
Ld l 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
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
Cj"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
[2/No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Callo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;Ko
❑ NA ❑ NE
Comments (refer to•question #): Explain any YES answers andlor 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:
Date: %
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routie 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: Ounty: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:mkchwC � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , l;oultr.
Layers
Design
C•_a aci
Current
P,o ..
Dry Cow
Non -Dairy
jBeef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars Pullets
Turke s
Other Turkey Poults
Other Other
Discharees and Stream ImD8et5
1. Is any discharge observed from any part of the operation?
❑ Yes P-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
T
a. Was the conveyance man-made?
❑ Yes ,ZNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ,ENo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes �No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes JET�4o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: 7 1 - Date of Inspection: L
/
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: _ �W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z -L—
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yesjallo
❑ 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 -1_5No
❑ 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 E]-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes�_12-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 JE�"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EINo
❑ NA
❑ NE
maintenance or improvement?'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes E ' o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3'�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes La -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 -E]—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 [3-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes L'No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of -Inspection: 2 f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes VrNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes PNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ,fNo ❑ 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:
❑ Yes
7rNo
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes d1VNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes JETNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2'1�o ❑ 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 oases as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: - j /Z / //

Type of Visit: 10<ompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: lergoutine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: Departure Time:, County: K Region: W /
Farm Name: i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: IM i r k o (; i - rrI
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: In 46
Certification Number:
Certification Number:
Longitude:
Design Current Design
Swine Capacity Pop. Wet Pouitry Capacity
Wean to Finish I JLayer I
Current
Pop.
Design
Cattle Capacity
Dairy Cow
C►urgent
Pop.
Wean to Feeder
I jNon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Farrow to Wean
MDTsi2n
Farrow to Feeder
Farrow to Finish
Dr. Paul Ca aci
Layers
P,o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Dther
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
OYes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field 0 Other:
d (n .1�`
a. Was the conveyance man-made?
0 Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
0 Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?�
B O O
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0No
❑ 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 1 of 3 21412011 Continued

Facili Number: Date of Ins ection: 42V�i
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 dNo ❑ NA ❑ NE
St ruc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 ONO
❑ Yes ENo
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ley
❑ No ❑ NA ❑ NE
maintenance or improvement? l
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA JZ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 4 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
;DNE
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
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ZNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
ZrNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
j aNE
the appropriate box.
7
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 9NE
❑ Weather Code
❑ Sludge Survey
❑ NA 6 NE
❑ NA YNE
Page 2 of 3
21412011 Continued
ir'

Faeili Number: 77 7 - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ No ❑ NA 12'14E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
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 E51NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No ❑ NA [2-NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA �E
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 ,j No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [-]No ❑ NA )2rNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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. o rrt s o fflucel�)
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �% / �' 7
Date: �j r< if 2 y
21412011 oZ 6 ,3

..ia Un�sion of Water Quality
FaCt�l�j'-Nuillb,er �:Dlvlsron of SOl1 and Water ConseLvation . '
.�.n
0 Other�Agency
Type of Visit 0" ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P4toutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Tim . rture Time: J�j�� County: /h Region:�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: �L ILA
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =1 0 0 I = Longitude: [_-1 ° =, =
Swine
Design Current-- a Design
.... . ;
Populatiop Wet Poultry Capacity
Current- �D sign �. Current
Population' 'Cattle Capac ty Po
,Ca
aet
p ty'
ulatton ,
❑ Wean to Finish
<
❑ Layer
n ❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
::
❑ Dairy Calf
❑Fee der to Finish
�� ��
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
-
El Gilts
❑ Non -Layers
ElBeef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turkeys
:Other
❑ Turkey Poults
❑ Other
❑ otherN
of�tru"� u umber cf res:
-�,
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
_E No
❑ Yes
1 NNo
❑ NA
❑ NE
❑ Yes
4: No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facili Number: - Date of Ins ecHon:51,
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
S cture 1 Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ff 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 UNo ❑ 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? 0 Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes O(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 P"N'o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wf'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1;9 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?
0 Yes Y No ❑ NA ❑ NE
❑ Yes Vf No ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes EX,
No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No,
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
0 Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
. ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [%
No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
P'No [DNA ❑ NE
and report mortality rates that were higher than normal?
77
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
0No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ff No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�No ❑ NA ❑ NE
Comments (refer to question #r): 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).-. `
...
Updk#rL
Ga
'
ReviewerlInspector Name: P
Reviewer/Inspector Signature: 1
Page 3 of 3
Phone: 70
Date:
12141011

C1
❑Wean to Finish
=' ❑Wean to Feeder
El Feeder to Finish
: ❑ �Farrow to Wean
= El Farrow to Feeder
❑Farrow to Finish
H;
Other
��Dtvtston of Wa#er Quality r'� �,�,,. ���
0„;•D�viston of Soil and�Water Gonservahon "�� '*' '�"" �"
Facility Number �
Type of Visit ompliance Inspection 0 Operation Review 0 Structure evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint Q Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
all
Time: Departure .� Departure Time: � County:
S l Owner Email:
Phone:
Facility Contact: Title: Phone No:
r
Onsite Representative: Integrator: T r
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
_Population,,
Back-up Certification Number:
Latitude: o Longitude: o
Region:
., ., Design Curren#.n Design "Current, Design., urren
Ca act Po ulaho 5wme fr .Capacity
. Wet Poultry �Capactty Populatton:�
❑ Layer�.
❑ Non -Layer
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
Dairy Cow
Heifer
' U Non -Dairy
❑ Beef Stocke.
❑ Beef Feeder
❑Beef Brood
�,....
El Gilts
El Boars
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
• other than from a discharge?
Page 1 of 3
❑ Yes ;2 No ❑ NA _ ❑ NE
[]Yes
�dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA- ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes' No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
. 12128104 Continued

Facility Number: — Date of Inspection
Waste C61lection & 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 A No ❑ NA ❑ NE
Structure I Structur 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z� No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes�No ❑ NA El
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 IZNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes Oo
❑ 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
ElNA
❑ NE
maintenance or improvement?
f
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ?&o
❑ NA
❑ NE
maintenance/improvement?
I
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes JVNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes YJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J�No
❑ NA
❑ NE
Eomments (referto qi ueition #): Explani„any YES answers and/or anyrecommendations or any,other
Use. drawings of facility to better explain situations.,(use additional pages as necessary) p
i
Reviewer/Inspector Name
�;y Phone: —
Reviewer/Inspector Signature:
/
Date: [. vt
I
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Re uired'Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNO ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PrNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes UNO
❑ NA
❑ NE
❑ Yes J3^Vo
❑ NA
❑.NE-^
❑ Yes Io
❑ NA
El NE
❑ Yes /;ZNo
❑ NA
❑ NE
❑ Yes [:To
❑ NA
❑ NE
❑ Yes ;?rNo
❑ NA
❑ NE
❑ Yes ,,VNo ❑ NA ❑ NE
❑ Yes 'PKo ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes EAo ❑ NA ❑ NE
Page 3 of 3 12128104

V
[Facility Number =7aill
.Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit (?,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint f ollow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: "Departure Departure ;rime: County: Region:
Farm Name:
►-61 t1) __� /_ _ I-) - 7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: P&"
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Phone No: c /�
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = { = " Longitude: 0 ° =1
Design Current Design Current- w Design. Cu
Capacity Population ''Wet'Poultry Capacity Population Cattle Capacity Popi
❑ La er
❑ Non -Layer
Dry,Poultry
1
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
Cl Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures y�
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
J
Yes io ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ,,0'No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

FacilityNumber:' t — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any..YES answers and/or any,: recommendations or any ofber comments
Use drawings of facility to better explain situations.. (use additional pages -as necessary)::.
pw - up 4; f50erc c7, ' s1 �/�� C'ai r ND �/! Gla i
/1�3rlr-c
Sl %1 !r✓� 7`C �PQd/G�Cr�r�! Gtl,�r/ T1�1/f �� �r
#
-
�Q WGjq� /t '0 GT (/r j-yrc Q I'll /S /�'tC� ! ���ril�ti�
.r /T<H o��r %s
ReviewerAnspector Name '!l� T ���
Phone: l
Reviewer/Inspector Signature: `
Date:
Page 2 of 3 I2/28104 Continued

Type of Visit lwcompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7 D Arrival Time: Departure Time: County: Region: _Z�
Farm Name: 7 C61v"" U,
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 4 n Seorair�.�
a
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No: J f
Integrator: a //(/�I9
Operator Certification Number:
Back-up Certification Number:
Latitude: =]' =] ' [_—] " Longitude: [=] 0 0' =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
I IE] Non -Layer I
I ❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish I
❑ Farrow to Wean Dry Ponitry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars El
El Beef Brood Cowl
I
❑ Turke s
Other ❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
�es
❑ No ❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
,poo
,Yes ❑ No ❑ NA ❑ NE
1'e 5�pNo ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
12128104 Condnued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: r),
❑ Yes ,ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 k3No
❑ 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? ❑ Yes UNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes ❑ No
❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ZYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J21 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
„0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J'No
❑ NA
❑ NE
'Comments (refer to question #): Explain any YES answers and/or any recommendations or''a_ny other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
CHI Le r��t// � �e/P CGn 11, 4e/ � � i//rt� 4T /r`S�CG A".1) e
`
bee, L
/Z1
/
Z'j¢1 r'ty,�Cr,%
Reviewer/inspector Name H t.! � Phone: 2
Reviewer/Inspector Signature: Date: 67?�
Page 2 of 3 12128104 Continued

Facility Number: 3 1 Date of Inspection 7 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo Cl NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,d No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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
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 O�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�]i No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
,0Yes ❑ No ❑ NA ❑ NE
❑ Yes ,0 No ❑ NA ❑ NE
10Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
ir
!2.1s 64?Cl
i,U�, vas c�sClv�G� f> �lrJct'�i� G�IY�Z G�GSJt-�5
Lave C rh�cl�l - l +7 �OGY11 j
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• Ao v4�t &17v-
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coel
Page 3 of 3 12128104

Q Division of Water Quality
[�aeiii
ty Number 3 Q Division of Soil and Water Conservation
-- — O Other Agency
Type of Visit QfCo pliance Inspection 0 Operation Review 0 Structure Evaluation t) Technical Assistance
Reason for Visit (O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: 0 b Departure Time: County: VPL-rU Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: DwK- &2—wtr NtitctiAE� IS4�+Lr _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = & =16 Longitude: = ° = A =
is
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
$DO
l (0
Farrow to Feeder
I aLKo
1100
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Cattle
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O No ❑ NA ❑ NE
❑Yes
❑No
DNA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0
❑ Yes
0NNo
Z NN.
❑ NA
❑ NE
❑ Yes
[2 o
❑ NA
❑ NE
12128104 Com inued

Facility Number: 3 1—,YE Date of Inspection 16 g
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: [F4V-C'j 1 L.Ca���
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q G
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes &o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes tLI 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 dN
hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Ye
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Elyes ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Ely C s LJ No ❑ NA ❑ NE
maintenance/improvement?
l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ICJ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
[I NE
18_ Is there a lack of properly operating waste application equipment?
El Yes
,�
L� 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):
SCEKAov6 a (_0 151R1_1 �f o
ri�LO NEE7.s LkVGLr.N G- wa n-k- AND
Is -TR. c PLAN iZ s W-TT(-Iq T W
0 (- w-LELvS
(W C-[- 0 C4NI 20 t� .
C,P-0 P1 ')
CALz P-enrtc o DvE of 'iC+V.22
Reviewer/Inspector Name o R tx— Phone: 9 l0 % ` 73
Reviewer/Inspector Signature: Date: b o

Facility Number: — Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
EA/No
ElNA
ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
3/No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
[I NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ YesIN
FNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes7NA
NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
;rNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
7
El NA
❑ NE
Comments and/or Dra
12128104