310428_INSPECTIONS_20171231

NUH I N UAHULINA
Department of Environmental Qual

'M
Y z
Type of Visit: OCom nee Inspection Q Operation Review a Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up 0 Referral D Emergency Q Other O Denied Access
Date of Visit: / Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 00 CAP ` r e_,r K t j
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Region:
Certification Number: M I f ( -2 C
Certification Number:
Longitude:
Ili Design Current
Swine Capacity Pop.
Wean to Finish
can to Feeder i 77
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
1?vp.
Design Current
Cattle Eapacity Pap.
Dai Cow
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
D . 1?oult
Design
Ca aci
Current
P,o
D Cow
Non -Dairy
fl
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
[]then
Turkeys
Turkey Puults
Dther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �00 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes
[:)No
[]NA
❑NE
❑ Yes
E3--No
❑ NA
❑ NE
❑Yes
[-9-a
❑NA
❑NE
Page 1 of 3 21412015 Continued

Fneili Number: jDate of Inspection: r
Vaste 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): �o
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 INio ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F3/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ' No ❑ NA ❑ NE
16. D'rd the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes�3<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?
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents �
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes L"J N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, 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 DIN❑ ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Yo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facillt Number: - Zip Date of Inspection: f 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Ye �Q'No ❑ NA ❑ NB
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 ❑-1 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes l__I No ❑ NA 0 NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
Ej­No
E] 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
❑'i o
[] NA
❑ NE
Comments: (e6fe iri tb',q u-'es ti 6n;..)i;Uplain any YES.'it nswers:and. ur:any;additlonai reed mmen at ohs'.orlany,.'0ther,rn rfie6 1;
Use drswln s of faeili to. Ete[ter ear' lii<ln;situatians'.(use.additiomal `' a es ss;necesar j ? : e9 §
n2
�L
Reviewer/Inspector Name: Y 6��' l {f� "� 1` 7 I �f ?3 �% ��
Phone:
Reviewer/Inspector Signature: �� �.�`+ Date: G Pee
01 ._, .,
Page 3 of 3 21412019

Division of Water Resources l
Facility Number ©- Z a Division of Sol] and Water Conservation
❑ Other Agency
Type of Visit: 0 Co liance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: t ( Arrival Time: T._ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 0 cf'r". Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 17 z
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder fl o
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Non-L;
Pullets
Other
Poults
Design Current
Yo
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 past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dory Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ ,a- ❑ NA ❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes YNO
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facill Number: IDate of Inspection:
o�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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 0
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 4 o ❑ 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
Zj No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9• Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
[] NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
eNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below.
[] Yes
J�:rNo
❑ 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
JLJ No
NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑' o
❑ NA
�] NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
El yes
E-No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
dt o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Reauired
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r
�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g
❑ 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 ❑ NA ❑ NE
23. If selected, did the facility rail to install and maintain rainbreakers on irrigation equipment? ElYes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacINU Number: - Z Date of Inspection:
--24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes ffNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes p ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 6-<A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ]�No ❑ NA ❑ NE
❑ Yes E:fNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
rN
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Corn eats (refer to queatiun #}: Explain: any YES;answera grid/or any ;additional recornmendatlons or. any other comments: .
luseledrasoffelit"v Oo letter ai la
win2iri situations`(us'addItidnal pages as neeessarv?: I
r
Reviewer/Inspector Name: Vt o--A q Phone: V f p
Reviewer/Inspector Signature: Date: sl lt
Page 3 of 21412015

Type of Visit: WCompliance Inspection L3 Operation Review ❑ Structure Evaluation O Technical Assistance
Reason for Visit: 01" 0utine Q Complaint 0 Follow-ue Q Referral Q Emergency ❑ Other Q Denied Access
Date of Visit: i 4 12 11 S� Arrival Time: Departure Time: i IJ County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Y III rT
Phone:
Onsite Representative: o L.—'A f �'r�} ._ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude-
Design Current
liesign
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
can to Feeder
IL70 n
on —Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . EouEtr.
Ca acit
1'0 P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
I
10ther
Discharr-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [ENo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 6/N"o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Z V pate of Inspection:
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes [:rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): k
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [fNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes E�I<o
❑ 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
D 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 [3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [:rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
[] Yes [j-'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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops dii%er from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes2'�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ENo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�rNo
[] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
[] Yes
[fNo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[E�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If'yes, check 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 �Na ❑ NA D NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Zf No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

z
Facilit Number: Date of —Inspection: j-
24• Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CD/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes MNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? EKes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �rA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E] 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
2INo
❑ 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
�10
❑ 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
03"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
[g-g'o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rut'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ErNo
❑ NA
[] NE
Reviewer/Inspector Signature:� Date: Z 1 5
Page 3 of 3 21412014

Division of Water Quality
Facility Nurnber ❑ - Division of Soil and Water Conservation
0 Other Agency
type of Visit: Compliance Inspection , 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C26outine 0 Complaint 0 Follow-ut 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email: " '
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _ TkA 5■ 6h
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
other
Title:
Latitude:
Phone:
Region: r
Integrator:
Certification Number: ca,
0gia 1�
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
191
Non -Layer
lets
Poults
Design Current
Discharges and Stream Impacts ,
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes PfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
F 10No
❑ NA
❑ NE
[:]Yes
]No
[DNA
❑ NE
Page I of 3 21412011 Continued

• Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PrNo
❑ 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 totheintegrity of any of the structures observed?
❑ Yes
j6 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
77��
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes-
ff 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
6 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
7" 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
;6No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;;4-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZrNo
❑ 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
Fr&o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0-&o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vno
rno
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes A No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes P-No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists [3 Design ❑ Maps [] Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ZNo
❑ NA
[] NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ZrNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Faclli Number: 01 1 - L4 I Date of Inspection: Pill
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;ETNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;!jTo ❑ 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 anchor document ❑ Yes ;?!rNo ❑ 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.
❑ Yes ;No ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ;�`No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes pno
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PfNo
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes PTNo
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: � ! ." 61
�t;Qj5 6
Date:j� 1� I
21412011

Division of Water Quality
Facility Number - f-} 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency ❑ Other 0 Denied Access
Date of Visit:
Arrival Timer
Departure Time:
County:
Farm Name: �.
��„j('�
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region: WaL
Onsite Representative: N1 ��(- Integrator:
.. .
Certified Operator: _AA [�'��' S,]v-� Certification Number: D '�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouits
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 past discharge from any part of the operation?
t.
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes RfNo ❑ NA ❑ NE
❑Yes ❑No DNA ❑NE
D. Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ZrNo
❑ NA
❑ NE
❑ Yes
ZrNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of lns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C2r'�❑
❑ 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): 1q,5
Observed Freeboard (in): Qt
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eNo
❑ 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
7-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
ZTNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
ZfNo
❑ 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 [a 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 ;;JO14o [] NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
❑ Yes
JEJ"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E20%
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ANo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2rNo
❑ 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
❑ 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 ZI No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o �] NA ❑ NE
Page 2 of 3 21412011 Continued

Facill Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ZNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes OfNo
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?
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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[6 No
❑ NA
❑ NE
[:]Yes
J!5 No
❑ NA
❑ NE
❑ Yes
EZ No
❑ NA
❑ NE
❑ Yes Z'No ❑ NA ❑ NE
❑ Yes r No ❑ NA ❑ NE
❑ Yes �ZNo ❑ NA ❑ NE
[:]Yes ONO
❑ Yes ETNo
❑ Yes E!(No
❑ NA [} NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facili(to better explain situations (use additional Rages as necessary).
VA�elr WIV'fV C4)_Vy)Q ;
Lo� VV'VN 6VNn - t90 �j y"-'-y-%1" 16\
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
21412011 r _ .

Division of Water Quality
Vadlity Number 3 1 - ® ❑ Division of Soil and Water Conservation ` f�
Q Other Agency
Type of Visit: OkIcompliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: ,Routine D Complaint Q Follow-up Q Referral a Emergency Q Other ❑ Denied Access
Date of Visit: 1979 Mi Arrival Time: ® Departure Time: I IQ X" County: Region:
0
+Y&Name: i�ouG L14� ,� �Q� I1V C p�neait: 901-1
� AI*" 1
Owww Name: y jrr�1� �' �iQ�l'� Phone:
Mailing Address: �] Dc AMl� CHLaC4 CZC- 0-TSOAt f %VC pQ ESO S- -_
Physical Address:
Facility Contact:
Title:
Onsite Representative:,t
Certified Operator: 4Q5o 14 trL S . 1>Q.4'rl . .
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Inteeggrrattilor::
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
l_+7!v 11,5co 1 1 INon-Layer
Design Current
Dry Poultry Capacity POE.
Layers
Non -Layers
Pullets
Turke s
Turkey Poults
other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
Longitude:
.� - M
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
❑ Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
C] Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

[lLadIq Number; - 1-1 Date of Inspection: ;g7gj 7/6
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: 1,4406 At
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 ❑ YesNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 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 ❑�A,pppllication Outside of Approved Area
12. Crop 'Type(s): �D CLg U•� < lg 5<l
13. Soil Type(s): I S j LSAUl LC-E
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
[]WUP QChecklists Q Design 0 Maps ❑ Lease Agreements
❑ Yes
No
[] Yes
No
❑ Yes
No
❑ Yes
❑ Yes
jNo
❑ Yes
No
❑ Yes
No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
ElWaste Application ElWeekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste T ns ers
0 Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections 0 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of'3 2141.2011 Continued

lFacility Number. jDate 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 C] 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 777777 �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑������"````No XNA ❑ 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? ,TTT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ YesA
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
'A 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
i No
❑ NA
❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments;
Use drawings of facility to better explain situations (use additional pages as necessary).
LIMAT)CW bkAE �'C) y
rjL'p4E SveUct- pv&� �ID
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: fig,J
21412011

S
Type of Visit Compliance Inspection Q Operation Review n Structure Evaluation Q Technical Assistance
Reason for Visit �$Routlne Q Complaint Q Follow up ❑ Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ��^ j Departure Time: County: L!!�1 Region -
Farm
Farm Name: `lam[l , EI QJ N `�Foq�Lm Owner Email: R
Owner Name: I G( S �A Phone:
Mailing Address: VuOds�aw c� Cguzcd IJ4 A oa'e7_1 5av 1 UG
Physical Address:
Facility Contact: Title; Phone No:
Onsite Representative: N1 ul A L�� 11Y Integrator:
�' 4C5,0AI.L 1 rf rr Pnq
Certified Operator: � • ����� Operator Certification Number: 19 l0 Dt f ..
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 6 =11 Longitude: 171 o =' 0 "
{, 2.1
Uesign Current '-s:^:. �17esig@urreniric Ca acit Po ulalion Wet Poultry Ca aciI'o ulation. , Cattle" Ca acit Pnutation
-P, .,•Y Rpm.,... ..� P. .,!Yt P., z.::,-�:.::. MP Y p
❑ Wean to Finish ❑ La er ❑ Dairy Cow
Wean to Feeder 1MR10 -La ei El Dairy Calf
Feeder to Finish ' "F"..h. " '. ❑ Dairy Heifei
❑Farrow to Wean yy
yyyy' :El Dry Cow
17r�,Poul�
❑ Farrow to Feeder Non -Dairy
❑ Farrow to Finish ❑ Laxers
❑ Beef Stockei
❑ Gilts Non-Layers
a.• El pullets � ❑Beef Feeder
❑ Boars ❑ Beef Brood Cv
❑ Turkeys e; .
Other ❑ Turkey Poults
❑ Other ❑ Qther 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 XNo ❑ NA ❑ NE
❑Yes ❑No
El NA
El NE
❑ Yes ❑ No
❑ NA
❑ NE
El Yes El No
El NA
El NE
❑ Yes )6 No
❑ NA
❑ NE
❑ Yes Imo ❑ NA ❑ NE
12129104 Continued

Facility Number: r —
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: LAC.OdV
Spillway?:
Designed Freeboard (in):. S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 "RNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA El NE
Structure 6
❑ Yes ANo ❑ NA ❑ NE
❑ Yes'ANo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fffAN❑ ❑ 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? )6
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
1 l .
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 ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
'Window
Crop types) oam C'V S 5
13,
Soil type(s) Ay-rftu_ o LF-
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
�Lhlo ❑ NA
❑ NE
Comments refer to question # : Explain any YES an andlor an' reeamineridations or Any. other. comments.;
( q ) P y y . Y,
Use drawin s of to better:ex lain situations: (use. edditionuia pages necessar ;
g.. y explain .. . g y).
Reviewer/Ins ector Name
—z-— a., , �...
z.• �''.
Phone: 9�R
Reviewer/inspector Signature:
__
Date:
Page 2 of 3 12128104 Continued

Facility Number: —L Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? ]ryes, check
the appropriate box. El WUP 3 Checklists 0 Design 0 Maps ❑ Other
❑ Yes P
to ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
E] Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑tXaste Transfers ❑Alnual Certification
0 Rainfall ❑ Stocking [] Crop Yield 0 120 Minute Inspections [l Monthly and 1" Rain Inspections [] Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 'oNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA LINE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYeslNo
No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? [I Yes ❑ NA ❑ NE
26, Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No 3�NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ySJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4 No
❑ NA
❑ N E
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
to
El NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings: f.
(fA t_.1 gWA71 e_W
Uj. A
ala51l 1 l .-�
rjoic, HT 7 d �.A� 1 a� 571 U- wF117,1VC�
�A�� 1
DC E �)(,E M?T 71 L ova � of
Page 3 of 3 12128104

Division of Water Quality
Facility Number �j J j �-]$` 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit ACompliance Inspection 4 Operatlon Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X-Routlne ❑ Complaint ❑ Follow up Q Referral 0 Emergency 4 Other ❑ Denied Access
Date of Visit: Arrival Time: L1!�� Departure Time: County: TIA/ Region:
Farm Name: �s A e► zc A/ FQq-m Owner Email:
Owner Name: J ou L w (-¢-w Phoue:
Mailing Address 5J C� D�AN� C���cH i'- �3 9(_eG? T52, V. A� 0953_
Physical Address:
Facility Contact: Title:
Onsite Representative:�]�j t
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:
Dcoc)
Operator Certification Number:
Back-up Certification Number:
1 -J L.D Jq
Latitude: = 0 0 ` 0 Longitude: ❑ ° = 6 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
d� Non -Layer
Other
❑ Other — - -I
Dry Poultry
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dair Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
l
❑
Beef Feeder
❑
Beef Brood Ca
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �j No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

FaciliFyTiumber: 3 I - yDE Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No El NA El 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: L66=�
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.)
5. Are there structures on -site which are not properly addressed and/or managed []Yes gNo ❑ 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 J�'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 ZNo ❑ 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?
It.
Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ YesNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or la 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) Caw W d9EA 1 S& S6 1 ]eR
13.
Soil type(s) AAA u U, i,L�:r
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0No
❑ NA ❑ NE
15,
Does the receiving crop and/or land application site need improvement?
❑ Yes [KNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,p' No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes =K�No
❑ NA ❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA ❑ NE
=. .. • : -... •. . 1� Y'�,.y :.�a.'N.�F�A7 �..��; ,� .. N.'S'.T. f l �•��'�[.�'�,',$
Comments (refer to question #}i Explain any YCS answeiri3:andlor any recommendationsanriaiiy gtheri.comments, t ,. ; , ,q :.
Use drawings of facility to better explain situations., additional a es°as;necessa }:; ?' ;
€� Y P P K ry -�. $t x,
LK3Q0/V rA( PO-06ESS' Gq7- F 1CLrAIG q PI-7 QA-) L. (174- GA&LcS
-To 'PL
Reviewer/inspector Name � -Iff -- �1� l�tl uJS � Phone: 9/ ' ! Cv��
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: I I -crag 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 3 No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists 0 Design El Maps Cl Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
ElNE
[l Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ jaste 'Transfers ❑/nnual Certification
❑ Rainfall ❑ Stocking [D Crop Yield 0 120 Minute Inspections [I Monthly and 1"
Rain Inspections []
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes .XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ( No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
X 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 *o
❑ Yes -AND
❑NA El NE
❑NA ❑NE
❑ Yes AN❑
❑ NA
❑ NE
❑ Yes 1� No
❑ NA
❑ NE
❑ Yes 4 No
❑ NA
❑ NE
❑ Yes JqNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
p)C) C4�) SusT CMC 7p (1'4t• ►-7T - 6 T C-V':S:4 q3L4 jW go❑IL
C, y7G/M5 (51CAC_7J0
12128104

Type of Visit 0
Compliance Inspectlon
O Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit
�A Routine Q Complaint
Q Follow up Q Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: = Arrival Time: {-- Departure Time: County: u Region: A—JYV6
Farm Name: Owner Email:
Owner Name: S . ���� Phone:
Mailing Address: - S)tD� a� b RAN_ ►�G3�it.i�E[r~- 5 . I►► �• $ o
Physical Address:
Facility Contact:
Title:
Onsite Representative: li�)Q(A C, n Cgvu )v !f) Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = n = 1 = Longitude: = 0 0 1 0 11
Ueslgn Current
Design Current
ilrsign Current
Swine
Capacity
Population
Wet Poultry <✓hpgc`ity Population
Cattle Capa� city
Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
® Wean to Feeder
❑Non -La Non -Layer
❑Dai Cali
❑ Feeder to Finish
DairyHeifer
❑ Farrow to Wean
Dry Poultry
D COW
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
❑ Layers
Beef Stoeker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Cow
❑ Turkeys
Uthcr
❑ Turkey Poults
Other
Number of Structures:
❑ Other
10
DischarSes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes 00
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ] No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2128104
Continued

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 1 Structure 2 Structure 3 Structure 4
Identifier: ^1?_ }EW,%J
Spillway?:
Designed Freeboard (in): [ ,
Observed Freeboard (in): 7
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 1`r No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes O 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 environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [A 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
maintenance/improvement?
❑ Yes ON❑ ❑ NA ❑ NE
11,
Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
ko
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
l 2.
Crop type(s) covw , t'x) 4a t4 i , SQtJ. ZEAAl S Q rin�
O►4 S TA-6
13.
Soil type(s) Ayrzy U I LLB
14,
Do the receiving crops differ from those designated in the CAWMP2 ❑ Yes
1P No
❑ NA
❑ NE
15.
Dues 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
o
❑ NA
ElNE
18.
Is there a lack of properly operating waste application equipment? ElYeso
tN
❑ NA
❑ NE
reIAJ. z� n.i,,.: :;,<:.... ; :*�:A- ..a,r�s•::.ns:.�':s&:43` �R•i..r:., .�i; �:>k�: ls�:&�.�-z��i;�..�.az�,>, 6
Comments {refer:to..•quewtion.#]: EaipEaiiisuny:YES uriswerstandlor,any. recummendutions orjany,other cammertts
s[]se.drawiri ►s'af.fticili ^to kiitier:cx lain'.sifiiatiousi uie i dditiunal; ages.. nsf necessa
;.y . x h :• . ,is�. _, {�'.. .
•Mti".{ .�,'S:�� � i.: , i': i : ..E .s :�t..: .•� � a•'Jf;
W 14 EN wag O! CG GQe1] COIKE-s 01 MAIL S r--N❑ Ca`x� TC.1
(4 M ratio► - 6 w.i! 6 i : q; nv : ► 0t *,V o,9­
�VGDF:/�►Q -�wG� Q r_
VJI L -A 1)V4Tn"m N CG eqG S T
Reviewer/inspector Name �V Phone:��3'���7��'�
Reviewer/Inspector Signature: Date: d �` d
Page 2 of 3 12128104 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 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 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis
❑/N/aste Transfers
❑/nnuai Certification
El Rainfall El Stocking 0 Crop Yield 0120 Minute Inspections [l Monthly and
l" 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
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PqNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1A NA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
4 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
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
4No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
tNo
❑ NA
❑ NE
Page 3 of 3 12128.104

QP Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit gCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: �Arrival Time: �] ad Departure 'Time: County: ))r�A R UAOO' Region:
Farm ]Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GU S l 6!1S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = O = I = Longitude: 0 0 = i = "
Design Current Design Current
Capacity Population Wct Poultry Capacity Population
ElLayer 1 [v I 5 n ❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
El
Feeder to Finish
El
Farrow to Wean
❑
Farrow to Feeder
El
Farrow to Finish
❑
uits
El
Boars
Other
❑ Other
Dry Poultry
❑ La ers
Non -Layers
❑ Pullets
❑ Turke s
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStruct.ure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El
Dairy Cow
El
Dairy Calf
El
Dairy Hcifej
❑
D Cow
El
Non-Dairy
El
Beef Stacker
El
Beef Feeder
El
Beef Brood Col
I
Number of Structures:
K 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 (4 No ❑ NA ❑ NE
El Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
Cl Yes
No
❑ NA
❑ NE
12128104 Continued

FaciliV Number:3 ) -yap Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes N 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 I—RG<�OA/
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 MNo ❑ 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 VI No ❑ NA ❑ NE
maintenance or improvementY
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WM No ❑ NA ❑ NE
m ai me n anc a/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes DQ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Fleavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 1 a 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
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P9 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
IM No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
§6No
❑ 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):
PGj . No SL.L4DC rZ 15(AQUeut {roqL 'a `� 5,eUELc
oV Eft
Copy OP 'OS' S LLAnS Cr StAQ.0 C-_y .
�]
5c-Klt� Ca ©F 10't o►C cQ�la
�' `�
PC'TTN GAlxtEs
NCra6/4 nL6a
i S 4 CaQnl Ai A (_ pR
U.kLM%A1470N NCPN! 4'_'
Reviewer/Inspector Name n_Mp/Up(4F,S
Reviewer/inspector Signature:
Phone: 19) 0 -'19 & _1 Q�
Date: I g Q�
12128104 Continued

Facility Number: '7j � — �� Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ 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
I] No
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
❑ Yes
09 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
t,Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2P NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
09 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
O No
[I 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
R] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,Z-No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

N ,.
Type of Visit O Compliance Inspection I O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit O Routine O Complaint O Follow up O Referral O Emergency O Dther ❑ Denied Access
Date of Visit: ral Time: jJ ' 2Z Departure Time: 'QQ County: _ 7f eXV Region: ;PD
Farm Name: d 4 -u Owner Email:
Owner Name: L-0ge— 1.7` 22? Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ,!5�elz7-A
Certified Operator:�� _
Back-up Operator:
Phone No:
Integrator: o!
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 E�] ' = Longitude: = ° ='
=
Design Curren#
Design Current
Design Current
Swine Capacity Population
Wet Pou[try Capacity Population
Cattle Capacity Population
❑ Wean to Finish I
Layer
❑ Dairy Cow
jK Wean to Feeder po(J
❑ Non -Layer
❑ Dairy Calf
El Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
Layers
❑ Beef Stacker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ $oars
Pullets
ElBeef Brood Covj
❑ Turkeys
Other
❑ Other
Tor ey Poults
❑Other
Number of Structures: 1
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
❑ Yes
❑ No
F[I NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1
�1/No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
1
8/44
Continued

i . _ t
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�j 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?: 6?
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.) 14
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes YNo ❑ 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 stealth 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
(Nat applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ❑ 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 > l0% or 10 lbs ❑ Fatal Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑1 Evidencce+ of Wind Drift ❑ Application Outside of Area ' d'
12. Crop types) ,&Z'4aaq
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
[I NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ 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):,
1,676AL z� ��� r ���G�2� �5nb � z,,. ���•,�� Q.� 3�z
Reviewer/inspector Name Phone: d23
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

R
)FacilityNumber: — Date of Inspection
Reautred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )ZfNo ❑ 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 fi�No
[]NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
�eNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes evNo
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ///❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes eNo
El NA
El 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 J6 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
90 � 5 5�r — F�B�J�fl F]�t�] fI�Ij>/�/f L� C'4f�� 5 � lYl o��,•�l ��
..r
®&.x A—re"94-42sk�C �} 3-0--2-C41v,o
4olv,
0 A,)
Page 3 of 3 12128104

B02412007 06:37 1-910-296-2985
UGH OPERATING ROOM
PAGE 01103
TO:
r �
A
w
DuPUN GENERAL Hosa?xTAL
A University Health SyrtrnuAffilia&
4oi N. Main Street - P.O. BOX 278
Kenansvd&, NC s8349-o278
FROM
Names
CAN
W 'e'o cle' �)o
Nam:
Fax: R
j b
Q A
Fharm
Companyl _ . Oewmant: -
DQparbwmi l Catel
Rec.
Numbor M pages lesall chn *oven
Commentst
Confide►atraW Notice., This fax is for the sole use of the Intended reciplent(s) end
may contain oonfidential and prJvileged information. Unauthorized review, use,
disclosure or distribution is prohibited. If you are not the intended recipient, please
contact the sander and destroy all copies of the original massage.

04/24/2007 06:37 1-910-296-2985 DGH OPERATING ROOM PAGE 02/03
rl
M11rpbrBzvwn I,!,- Contract Freeboard Levels 4118120Q7
&-nnnavjUs I7ivInInn
Fare1�[smr9MULLMM f= ,j fi ] 2911 Servicencnnn
13ou# Marring NUR 96537 1 27 U6146 Tory Sown;
snug Hemfng NUR 96557 1 32 Ili 1106 TM 9clunmx
Doug Horring NUK 96557 1 32 1118106 Terry Svssamx
Doog H9Ring NUR 96557 r 34 I125M Terry ,aewmp
Doug Marring NUR 96557 1 34 211 Am Tarry SeWM6
❑� r3nsig Herring NUR 9b337 1 3n INN Terry Smome
DOLIA Herring MIR 96557 1 30 VIM* Terry SW -"Ms
(Doug Herring NUR 96557 I 30 2121/06 Terry Sessome
Doug Herring NUR 96557 1 32 212RM6 Perry Semamx
Ikrug 14erHng NUk y6557 1 4.1 317106 Tarry Soa ms
Q MIJA I luring NrIR 96357 1 43 311,11n6 Tarry 541ulonlm
Nup Herring HUR 96317 I 43 MUM rcrry b4mimr
Ihnsg Herrin; NUR 96557 I 40 3121111T,16 TOMMAMMA
17nur furring NUR 96557 1 40 417M6 'rcrry 5omrem�
1Doug HerrinA NUR 963S7 1 35 All [NOG E'orry Sasssamy
Doug Honing NUR 96537 1 30 41I9106 Terry Seex+mn
�} Doug Herring NUR 96557 1 7H 4126/06 7ssr'1T' sapsnmE
Q 1k+uc I furring NUR 96557 1 3h 3131116 Terry 5arxomx
^/tiff I1vup I ICRing 1411R %137 I 39 SlR1fa1+ 'i'crty Sopmrw
I)tpog I Icsrinj NUR 96557 3n 510106 Terry 4rrssnmA
I'migIIming NUk 4Po557 I 38 5122106 'ferry Soep"ms
Ik+uy Veering NUR 965.17 1 36 11311f}ry Tarry SalFnm11
I misg Marring NUR 90"7 1 38 1,11106 •INrry soswm
I� Doug herring NUii Wil 1 36 0.1106 'ferry Snswm
lk+uy Morrin; NUR %557 1 36 rsr2(06 'ferry Smt mx
1h+u4Ikrring NLIR 4ni}7 1 311 h127106 rcrrySemmvm
0 4 1 hiq I luring NUR 96557 1 ]V 71tiA16 Tarry Sessnrr,x
111 pis}! Iferrirk; NUR 96557 I is 711016r, '1'etrry f+>xpe+ma
DmI2 rlerrilig MUR Orm7 1 411 7"1 RM Terry Sesxnlns
Dmip 1 Icrring NUR 96557 I 32 71Z4(00 Tarry Sexxomx
11[lug 1 Ivrrriry NUR 96337 1 32 71.111ht, Tory 9eprolm:L
Im.011err1ng NUR V6557 1 32 $1I I106 Terry Smoms
Ik+u; l len ink NUR 961.17 1 31 8116/06 Tarry 9csMmx
11nuy I icrring NOR 96557 1 35 RR21M6 'ferry Smarm
I h41IC I kreMg NUR 1tos57 1 4+a r.:v:rm 'I urry lkmms
I suit'! I furrin1l NUR %557 1 39 015MIN Parry i, 41mirrlp
ixuns I Ierrmg NUR 96557 1 411 V112106 TerrySawinx
I A-11W I (erring NI m 91,457 1 411 91220106 Tarry Se-mmti
milt; I ILtrnn4 NOR 46357 1 411 91'_i11116 •reap Sclw(Ims
MgIIr I I+•rrin; NUR 465S7 1 •III 10/3101 'Perry Scmamx
I1nn; I (amine NUR 96+17 1 40 10,I)1116 Terry Sessamx
l h%li� I (camp NT IR W57 I 40 161111/06 •rerly Sesxnmx
1 huiti I I:rrmg NOR "M 1 411 111r25#)6 •rcrry Samomx
i I kmnu NOR 96557 I Ali 1111,311015 'rout' Scums
1 I krrmy NOR 96557 1 40 I I/6101% Tarry Spy 1e+mx
I h iil I Iorring NUR 9(1537 1 38 f IIIW06 'C,srry Kcx!u,mv
1s „yr I leering NUR 96557 1 3B 11,121416 'rcrry Suxpams
I�ai;• I Icrrirty NUR 1)65.17 1 3i 1 Ir27.11r, 'berry Kuxwims
Page I nr2 • durnMik 11rx1-slope lugnan

04124/2007 06:37 1-919-296-2985 DGH OPERATING ROOM PAGE 93193
:1
MiUrpby;-BrX)Wh Contract Freeboard Levels
Ran AnvvdIt Divi Mon
4/Ig/2007
FjrM Name re"'r Niffie
Perm
Tyne
Grower Lawn
g N
. ri1
pft
$pwicrnl;ren
hou; Naming
NUR
96147 1
34
12/51(4
Terry Samme
Vouy herring
NUR
96557 1
3p
121i2N1h
rAryl Puirull
17vua mcnInR
NUR
9057 1
Daryl finrell
❑ougHernnp
Null
96537 1
31)
1j12(wn6
Deryl Futrell
One 2111,2 * dunute• ni-Ni••iuLc luLaan

Type of Visit 0,,C[[ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit /V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �j� Arrival Time: ❑r'pp Departure Time:
Farm Name:' Le Owne
Owner Name: Pho
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: tJlye ifs Z-A (,.
Certified Operator:.5z,,�-..,_
Back-up Operator:
County:
r Email:
ne:
Region: i:d�Csi
Phone Na:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: . Latitude: 0 0 06 [ s Longitude: = e = L 0
is
Design Current Design Current "Gap�clty
Swine Capacity Population eouryCapacity Popuatonopulation
urrent
inish
Laver
❑ DairyCow
eeder
Non -Layer
❑ DairyCalf
10 Finish
EFarrrow
ry Poultry
❑ Dai Heifer
❑ ❑ Cow
Non-Dai
Beef Stocker
❑ Beef Feeder
❑ BeefBodTurke
Number of Structures:
Wean
Feeder
Finish
Layers
❑ Nan -La ersPullets
FOEts
ars
s
❑ Turke Poults
er ❑ Other
Discharges & Stream Imparts
Is any discharge observed from any part of the operation? ❑ Yes 1z No ❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:]Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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: Al
Spillway?: fijo
Designed Freeboard (in):
ZZZY
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 k No ❑ NA ❑ NE
❑ Yes 1ZNo ❑ 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
gNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;eNo
❑ 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
Cl 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
X No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. ..: .
Use drawings of facility to better explain situations. (use additional pages as necessary):
2) A4740 /f �_ecolzos
Z'g ez5) IAA /VSX'o "0'0'V , 2 C06 ,
Reviewer/inspector Name Cr - -- _..._ Phone:-q —
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Reuulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes /No ElNA ElNE
ElEl❑ Design ❑ Maps El appropriate box. WUP Checklists p 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 XStocking ❑ 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
FerNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ 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
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�XNA
❑ 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
�dNo
El NA
El NE
If yes, contract a regional Air Quality representative immediately
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
to
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�z
7No
❑ NA
❑ NE
Additional Comments and/or Drawings:
119A40S Alln r- _Z;� elo u w o
l�,Irv�or�.
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspectlon O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit o Routine O Complaint O Follow up O Referral O Emergency O Qther ❑ Denied Access
Date of Visit: 5 1 Arrival Tim ' 0 Departure Time: ounty:
Farm Name: fi 0-40 Owner Email:
Owner Name:. Phone: —
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6'0'V ' F e
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
i
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: w•;49
Latitude: Ell
=1 = si Longitude: = ° ❑ i 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
j ❑ Layer
Z22(p 1 JEI Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heitei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: 141,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes O No ❑ NA ❑ NE
El yes 0No El NA ❑NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus hearty rainfall) less than adequate?
❑ Yes V1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Stfu ture 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
r
Designed Freeboard (in). 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No ❑ NA El
(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?
.0
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7, Do any of the structures need maintenance or improvement? ❑ Yes Z No ❑ NA ❑ NE
8. Do any of the 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 ❑ Ye5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JKNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )ZNo ❑ NA ElNE
ElExcessive Panding ElHydraulic Overload ❑ Frozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ac I
ptable Crop Window vidence oi' Wind Drift ❑ Application Outside of PTea �}
12. Crop type(s) ® � •�� l�JdfltS�sF�
13. Soil type(s)
14, Do the receiving crops differ from those designated is the CAWMP?
❑ Yes ,,Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes P(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?o'Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes � No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes XNo
❑ NA
❑ NE
1 ��- 96116 F ��7f R rnz N ►47XOf4 %UFe,,06,a 1�C46_5 � WJYP
1&701� _ ��.�f►'� � •� av� &mil '6V' �- 4'e
A 5 0 Pg�tJ&L- ,Ti95 e•44re,FP
Reviewer/Inspector Name °''3 s " `r;,. ,�k Phone:
Reviewer/Inspector Signature: Date:
12/2VO4 Continued

Facility Number: Date of inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ ether
21.
Does record keeping need improvement? If yes, check the appropriate box below.
OYes
❑ No
❑ NA
❑ NE
❑ Waste Application [:]Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield 0 120 Minute Inspections [:]Monthly and V
Rain Inspections [a
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[;XNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[INA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-comp]lance of the permit or CAWMP?
❑ Yes
P(No
Cl NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ YesNo
❑ NA
ElNE
and report the mortality rates that were higher than normal'?
e
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
11 No
❑ NA
❑ NE
Il'yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Adiii#ifon�l'Commeiefs rindlor_Drawl 's:;;
_. ['. . A' � :-�,.%a :w.Y. 1e.� �e� ir,�!1.. i'•'p-". :!i��.::;u�f4....,
N) A� PU 0,06AA7,00,9 /45 VJ:: P-M I e N r
4c a,, � _e, Od _W4 e - 2, 1 Ov -, v
d � �oufr� C►QaP � 1.��'a .l � �o,��'z.�u� o
20
GfJA rri� ■ '� 6L
��- �► ofo fo,/2 Ind
�07� • �rli:�'i9�� �I>�2m
AUM X,261,,49 Z,+C, o od
12128104

ITYpe of Visit OCompliance Inspection Q Operation Review D l-agoon Evaluation I
Reason for Visit q'Routine Q Complaint Q Follow up D Emergency Notification Q Other
Facility Number bate of Visit:
M'Permitted jfCertined ©IC`onditionally Certified 13 Registered
Farm Name: ..........................................
Owner Name:..., ....... Q.L� }C�.S`./. �.........................................
MailingAddress: ....... ............ ................. .................... ... . ....... . .......... . ..............................
❑ Denied Access
!v � i Time: ��
Not Oaerational D Below Threshold
Date Last Operatgd or Above Threshold: .,
County:..,, (1.42A...?..............................
PhoneNo: ... . .............................................. . ............................... _.
FacilityContact: ........... ..................... _[..f................................. ... Title:................................................................ Phone No:...................................................
Onsite Representative:. E11 [• ..11�rtrl..................................................... Integrator: �,�411............ ............................... .............
Certified Operator: ................................................... ........... ............ ...... ......... ............. .. Operator Certification Number: ........ ......... ............ ..........
Location of Farm:
wine ❑ Poultry ❑ Cattle
❑ Horse Latitude Longitude '
�.. j.
t ' Designs Current '
:.::: :. , 6' Current E.
Dessgn ;, Current.: ;:;=, r; : 'Desivvnn
Swuze: P ulaon'�
:� Ca ace ,. o
oultry. �;, .. l ? Ca Cat
' aei ulaii' n ? !cattle .:i. 1�.,, ..:1 Ca ` mci 1
Po a i.ti.� . R Po` u ation
can to Feeder
/ [�
.; '.
❑ Layer
-F ][3
Dairy
J
Ef
❑ Feeder to Finish
❑ Non -Layer
❑Non -Dairy
a:
+'
❑ Farrow to Wean
.. �: fir. ; { it
,,.,; �.
Farrow to Feeder
Other
x F , ; I 'J.i ••n
j: y! ...�. � li
",�
Farrow to Finishi
:.>-... �. .. :....: ?�..!���,
is
el.. • ��; � ..... Total `Desi�' �/{yii Capadty.
i':�",[!,
El Gilts
.�l -� .:Yh Si � � S F�
•':t i:y�i:l fSL?Lf4: :i•1. ,., r x2 i.
;'
Boars
a-
�..:; Number of LagoonsIL,+
1�" '3i1• ".i•'��. Yili. ! : .. .i' �'' ��,. I3 ..5 %;{? j ' niir 'ii litr1
" Nnldina Pndef 1 Cnlid T ranc °....a{'r.nj•i: �y{'! f,,
::. ]s(`�r�.l
Discha_rees , Stream lmoacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 2I0
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,<o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
S cture I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: ....................................................................................................................................................................
.........
I.............
Freeboard (inches):
12112103 Continued

Facility Number: 3 Date of Inspection ,S
Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes '0&0
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or ❑ Yes ZNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Oqo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes eNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ETNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancetimprovement? ❑ Yes .E�No
11. Is there evidence of over application? If yes, check the appropriate box below, ❑ Yes P No
❑ Excessive PondinglI [IPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑yy Copper and/or Zinc
12. Crop type &a_5,41 //.-,g z, ). </, Aa J 1 . e_,17ZW,, _o vb 45.sS, .. APQ K 1- /T'nln
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 2No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ENo
b) Does the facility need a wettable acre determination? ❑ Yes O"No
c) This facility is pended for a wettable acre determination? ❑ Yes 2,90
15. Does the receiving crop need improvement? ❑ Yes 21�0
16. Is there a lack of adequate waste application equipment? ❑ Yes PNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ZINO
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 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately.
.. :. �.:�.;,.,,...,.�... ::_....:::•..:::,:v..;x:�:.. ,..-i.._..t..-,�.m:,:;.,�.s.....-.._tm::q+dfw;f•e..'YI�iI:J.::�..- ,o.n:.n�r.-�.-.... . ,:rlm .«r. sn��l,��n
ComEmeats {rater. tv quest�aa #). ;,Eicpla�ni asgy 3YE.5.answers andlor,any,, re ninale datlons or.an otltier, comments...1, 4
d la A I'7d } h. ..k,a ��.I Nil y y�.+.l.
'Use drawings of facility to fetter expiate situations {use additional pagesas necessary): k - ❑ Field Copy ❑ Final Notes ii444sv t
' f�', v�,.��s r Vla k� r;?;c E, l'I '•n.,i N��E:, si
;: n. ,..,'... �:+.... rl. „� '4 Irl�� d�ir:r�•k?r1;'�G���}i.. 1±�_ i�: A ::u, s�:��.:� �'7i''m�"''"D ,Hrli
r
�J Pl
eQS C❑ 1 IAA. S 4-C7 tC3 S CxeL� a� #0 LL �6 j
` = Good ef�rfis have- 0u n
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: Date of Inspection
'keauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ''No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
❑ Yes
(iel checklists, maps, etc.)
,0No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C3,140
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
,2No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
j2No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(iel discharge, freeboard problems, over application)
❑
,811�o
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑'�1a
28.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
2 o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑'No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

t .N
Type of Visit Qf compliance inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint a Follow up ❑ Emergency Notification Q Other ❑ denied Access
Facility Number Date of Visit: Time:
rO Not Oncrational. 0 Below Threshold
U Permitted O Certified 0 Conditiona y Certified Q Registered Date Last Operate r Above Threshold•.
Farm Name: �r�� County.
Owner Name: _ - ___-��'d( z- Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Awr Integrator:G I
Certified Operator:
Location of Farm:
Operator Certification Number:
d4wlne ❑ Poultry ❑ Cattle ❑ Horse latitude " 6 .6 Longitude • S �K
Design Current Design Current... Design Current. .
Sw ne Capacitv Population Poultry Capacity Po ulation Cattle Ca acit ..POD ulation
Wean to Feeder ! ❑ Layer ❑ Dairy
El Feeder to Finish ❑ Non -Layer ❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 'tA ❑ Subsurface Drains Present
...F3olding Ponds 1Solid Traps ❑ No Liquid Waste Managen
Discharges & 5tream Im a
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav 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 systcm? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area ILJ Spray. Field Area ICI
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Stricture 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes gNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑Yes
)Z(N o
Structure 6
Continued

Facility Number: — ]late of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes Na
(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 Z No
8. Does any part of the waste management system other than waste structures require in a i nten an ce/improvement? ❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste ARRlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑
11, is there evidence of over application? �] ) xcessive PWding P PAN ❑ Vydrau�jc Overlvac ❑Ycs No
12. Crop type
Cyr;
13. Do the receiving crops differ with those desi nated in the Certified Animal Waste Management Plan (CAWMP)?
❑Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[ No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
IQ' No
16, Is there a lack of adequate waste application equipment?
Oyes
/❑ No
Required Records -& Documenis
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
I
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VNO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XN,es
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;2No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
22, Fail to notify regional DWQ of emergency situations as required by General Permit?)ZNo
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ YesNo
24. Does facility require a follow-up visit by same agency?
ElYes
XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments.(rcfer:to;questivn.#}: Explain any YI✓S'answers andlor;any.Rkommendations.or, any.vther.ctimment�r ^
.. .. ... �.:..R?.,,,,..R:::.v:.:.:.:.F°.:Ikri::.i:.i:°
i
UseAravings'of.facility;tv.betterexplain situations. (use a dditional;pages.as necessary}; b k•; Field Co Final Notes " `'
"� t�Y ❑
i sa"s�
�:a
vr.lr7rtiL{� ! 0 4►Q rV Aa F e 5 VAPF Z,46-60A)
AAP r� �i� Eq � JO IUW 7_
H
Reviewer/Inspector Name `::: ; .. =::::" :..:'..::•.::.;,>
Reviewer/Inspector Signature: Date:
051031VI - Continued

I IV
Facility Number: Elate of Inspection
Odar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ;dNo
❑ Yes No
❑ Yes No
❑ Yes dNo
❑ Yes 0"] o
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings: .
D rAv�IV r�VNROPOR 7,
�1 G,Qo,v
&V"z &,0
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5_

I E
Division of Water Quality
ivision of Soil and Water Conservation.
0 Other Agency
Type of Visit gkCompliance Inspection Q Operation Review ❑ Lagoon Evaluation
Reason far Visit �6 Routine ❑ Complaint O Follow up 4 Emergency Notification Q Other C3 Denied Access
Facility Number
Date of Visit: ~Q� Timc: ❑ = Printed ton: 7/21/2000
'�
O Nut Operational n Below Threshold
*Permitted © CertifiedLC'.ondi.,,.,t1onally Certified © Registered Date Last Operated or Above Threshold:
W.' .... ......
Farm Name:�L!1.......................................................
W. .............................................................. County:
OwnerName: ................................................... ........................................................................ Phone No:......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ................................................... ................................................................. ...........................................................1............................ .........................
Onsite Representative:.G.A.nk!............................................................ Integrator:....................................................
Certified Operator: ................................................... ................. ........................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude • 4 «
777
"A:
Design Current
swine-: Capadty Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Deixi*a ; Current
Poultry Capacity population Cattle Npulaiion
Layer ❑ Dairy
❑ Non -Layer ❑ Nan -Dairy
❑ Other
Total Design Capacity
Total SSL W
Nt>Einber ofLagaoltls ❑ Subsurface Drains Present ❑ Lag•mn Area 10 Spray Field Area ,
Ildding Ponds / Solid Traps ❑ No Liquid Waste Management System ! �'
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: []Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made? [:]Yes [:]No
b. If discharge is observed. did it reach Water of the StateY (If yes, notify ❑WQ) ❑ Yes ❑ No
c. II• discharge is observed. what is the estimated flow in gal/min?
cl, 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 KNo
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes t'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:...................................................................... ...............................................................................................................................................
.
Freeboard (inches): 36
5/00 Continued on Lack

10acility Number:3 $ Date of Inspection 0 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 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 O�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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes (KNo
Waste Application
10. Are there any buffers that need maintenancelimprovement'? ❑ Yes N'No
11. Is there evidence of over
12. Crop type
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewerllnspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance oi'the Certified AWMP?
yiQl'a i9nis:ar. d�fie�e t ie5 v► re �p�e� #>►r`E� tit}s;v�s�t; Yvu wi�� ec iye a #'u> t er '
. .. ...
carrespvndeh& abaut. this visit_
❑ Yes g No
❑ Yes D(No
❑ Yes JqNo
❑ Yes ❑ No
❑ Yes ❑ No
I Yes ❑ No
XYes ❑ No
XYes ❑ No
h Yes ❑ No
❑ Yes 4Na
❑ Yes 4 No
[]Yes [yjNo
❑ Yes NfNo
❑ Yes RrNo
❑ Yes No
❑ Yes R1a
,.
Comtnents.(refer to question #}; Explain any YES answers and/or arty eecommendatioas or any; o er. corntnents. `1-11
. . .
Use drawita s of faciti to better explain situations. ease additional a es as necessary � i. , s# 5�
drawingso ...... h ..... P .... -. ... ( p.g ..- .. ry)�. �;,. t'.,, .:` ` j..;;i E:��s?,j.'.I:°; ':...'. ��1
A.
r7) S, [ [ [1 E 1
�a 2 a,,,-���e�-�d c ��a..� �r e►� C. [4.�-yew + ve5� t
vye- • ,io.4 [mot �_ �•.'1"lei Chi � w h4 5�►-t ,
LA
Reviewer/Inspector Name ' r ' ; i' "
- G l p� F
Reviewer/Inspector Signature: Date: �Q 5/00

Facili y Number: • — 5a' Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Wes ❑ 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 54 No
IT
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property) 1}
24. 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 blades), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 8fNo
Additional omments an or Drawings:
�-- t.�w CU-G S�f�. s' ,SL.H'►�2�- tea
c� � � ❑�s�re +,-.cw � ��� �..�-+-�� y e�+- saw sQ� �, ��� �e.�-
fit
�—'-
el
�L--
T
5/00

0 Division of Soil and Water,Con'seryatia�t - Operation Review k.
13 Division of Soil ani3 Water Couserr+ation ,Complia nee Insp etion °
.WDlyision of Water Quality Compliance Inspection :�
0 , f
.. v
Other Agency • ❑peratxon Review f € f.,•:`i',
Routine
Follow-up of
Follow-un of DSWC review O Other
Facility Number 3 Date or Inspection
'Time or Inspection 24 hr. (hh:mm)
rmitted [ertitied [3 Conditionally Certified 13 Registered Not O erutional Date bust Operated:
Farm N:+me: ...... `e.11Lj!1................... Cif%1 ... ...... 1 ........... County:......... . ..... - ...... I ........... ....�--
❑wner Name: V i'i� �� Phone No: �sa' ��
.........
.................................J.�..........................................I.....................
FacilityContact: .................. 1�t �...,. �Z............ �g�, ............................................................Tit[e:................................................................ Phone No...................
MailingAddress:...............................................................................................................................................................i.�i
.................... ..........................
Onsite Representative:. �•••:. oA............ Irtlef;r:ttor:............................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude r-�0 ' •4 Longitude �• �� �66
Design Current Design Current Design Current I,
Swine.. Capacity Population Pouitry Capacity: population ., Cattle Capacity Population
Wean to Feeder 17 ❑Layer ❑ D:�iry
❑ Feeder to Finish Non. -Layer ❑ Non -Dairy
❑ Farrow to Wean -
❑ Fat -raw to Feeder ❑Other
❑ Farrow to Finish rr d� Tut• Design Capacity
❑ Gilts ,
❑ Boars T'otayssS w
,Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
HoldingPonds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. I£ discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (Iryes, notify DWQ) ❑ Yes ❑ No
c, It'discharge is observed, what is the estimated flow in gal/min?
d. Docs discharge b aa", a lagoon mcm? (Il' es, notify DW ) ❑ Yes ❑ No
$ YI b Y• Y ' Y Q. .
2. Is there evidence or 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 WNo
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): .......... � ..r'......................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, KYes ❑ No
seepage, etc,)
3/23/99 Continued on Back

Facility Number: '-:S— qa&l Date of Inspection
Are there any immediate threats to the integrity of any of the structures observed? (iel 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 maintcnancelimprovemew?
8. Does any pat of the waste management system other than waste structures require maintenancelimprovement?
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 nrtintenancelimprovemcnl7
fX]L�
❑ Yes KNo
❑ Yes o
Cl Yes XNO
❑ Yes �No
❑ Yes *
11. Is there evidence of over application'! ❑ Ponding ❑ Nitrogen ❑ Yes X 1)
12. Crop type ..... l d......... f%7�+�'............................................................I......'..
API .......�� J. �.. r�f� ...........�I............. f..........................
13. Do the receiving craps differ with those designated in the Certified Animal Waste Management flan (CAWMP)? ❑ Yes KNo
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes *10
15. Does the receiving crop need improvcmeni? ❑ Yes KNNo
16, Is there a lack of adequate waste application equipment? ❑ Yes KNO
Required Records & Dorinuents
17. Fail to have Certificate of Coverage & General Permit readily available? AYes ❑ No
18. Does the facility flit to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc:.) ❑ Yes 7 -o
19. Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports) E Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes AIo
21. Did the facility fail to have a certif fed operator in responsible charge? ❑ Yes �Vo
22, Fail to notify regional DWQ of'emcrgency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes kfl�o
24. Does facility require a follow-up visit by same agency'? ❑ YesX
0
IVQ.vialativns,nr. deficieriues :were noted. du'rinj :this visit:: You i freCeive na further : .
err spntideir ce: about this visit.; • . . . : .....::::: : : : : : : :: :
Comments (refer to question #): Explain any YES answers and/or any. recommendations.or any other comments. - : ,,+ • i I'
�...
Use drawings of facility to better explain situations. (use additional pages as nece'ssary): -, .'' ;• I ;i r a �, {; .:t; ;..: !;
tY� � ��{� � 3'� g' jr�d {� S �r�J 7��.'� � � �>•o � ca.+.._-�.1c.� u�
1 /0 t,'� ► ArL 41y00 IdaY). �`�s-�- �r �� � rc-S
t7�G �mw�>r t ee y of �'�o- -. Ca fro•- � eQ�.� o.F G -.�.� r � ��
'w � t rt .�.r�- rcr� t►Gr aC5 f /� � fJ
1� ■ 1 � .. eye P trr -f-G Ll A ■ ill�d�1./ ►-lv'LrRJC.�� � 1 /�✓ai �ff d�O.r�-,� F1'✓ Li YLiti.t�..en/� �., _ �
nspector Name M.. t
rReviewer/Inspector Signature: Date. 5 US 1 116199

Facility Number: — Date of Inspection
Odor Issues
4r
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aVor 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? ElYes I No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property) ,V
29. Is the land application spray system intake not locaEed near the liquid surface of the lagoon? ❑ Yes o
30. Were any major maintenance problems with the ventilation fan(s) noted'! (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.) ❑ Yes (�Nc
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes la
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? ❑ Yes �No
Additional Comments and/or Drawings:
mu �' 1? ki5 �7 -Or' � C 5� S �'f W s �G{ Pt Cv�1� p r� Ot
fv� 3 .
3/23/99

E] Division of Soil and Water Conservation.'- Operation Review
�i ;, 13 Division of Soil and Water Conservation' -.Co Inspection ;• .G a k; �s' ''' L
i►+ision of Water Quality!- Compliariice'Ittspecfivn .. .. I'� �' .�
g cy Opera otn Review ,'a .
Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date 4Inspection
Time of Inspec.lion 24 hr. (hh:mm)
ermitted Certified 0 Conditionally Certified © Registered Not O erutinnal Dat st Operated:
Fari .......- as .........1-!..Y....... County: ...............
uunty:............... ...............................
Owner Name: Phone No:
.... ...... ...........................................................................
Facility Contact- r....'.,.................... ............................Ti#le:.....l..f�t'-•"r.••L+r{••--•••••••....................... Phone No:
Mailing Address: .................... r .. ...........
..............................................
❑nsite Representative:.... :......!....A.......... ..Z.�. ............................................... Integrator: _.,............ ......................................
Certified Operator:
Location of Farm:
Operator Certifictition Number:
Latitude Longitude
Design Current IV Design Current ,: Design Current
Swine Capacity Population. Poultry' Capacity' Population Cattle Capacity Population
can to Feeder 7 ❑Layer ❑ Dairy '
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JEI Other
❑ Farrow to Finish Total Desiiv.Caparity
❑ Gilts.
❑ soars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray field Area
Holding Ponds/ Solid'Traps ❑ No Liquid Waste Management System ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? Cl Yes CNo
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 gathnin?
d. Does discharge bypass a lagoon system? (If yes, notit'y DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes QNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ` -No
Structure i Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6
Identifier:
Freeboard(inches):......... 1..."............. ........................... .......... .................. .................. I ................... ... --.......... I........................ ........... I.......................
. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes j�Io
seepage, etc.)
12319
9
Continued on back

Facility Number! — Date of laspcction (�
6. 1kre thA, structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes �AI' o
8. Does any part of the waste management system Other than waste structures require maintenance/improvement?
❑ Yes [N�qo
9. Do any stuctures lack adequate, gauged markers with required maximum and tninimunt liquid level
❑ Yes *Vo
elevation markings?
Waste A pplication
la. Are there any buffers that need main tenancelintprovetnent?
❑ Yes (�
11. is there evidence of over application? ❑ Excessive Ponding PPAN
fi�S�s
El Yes
12. Crop type, .O (
Aa
13. Do the receiving crops dif •r with those deAgnated in t eCertified Animal Waste Management Plan (CAWMP)?
❑ Yes [ o
14• a) Does the facility lack adequate acreage for land application?
❑ Yes 13' 10
b) Does the facility need a wettable acre determination?
❑ Yes Py'so
c) This facility is pended for a wettable acre determination?
❑ Yes P60
15. Does the receiving crop need improvement?
❑ Yes [ZN0
16, is there a lack of adequate waste application equipment?
❑ Yes [�(No
//
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes VNo
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ YesAIo_
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes O-No
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
❑ Yes 0cj-
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes 'o
24, Does facility require a follow-up visit by same agency?
❑ Yes rTNo
/
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
ElYes gNo
o VIDIa t1. 0 ti. 5 fln ii�# C�enOM •V1'0 iO0ed- dtti{;ttig 4:his•vjsjtt • y0b #ill •teboi'ye tia ruj�#ho
Corresp6Tidence. a�aut. this visit..
�;r,�
Comments (refer to question #):, Ex' plain any`YES.ans►vcrs and/or,any'recommendations':nr nyfuther eornments. !
., e .
Use.drawin of facilit „to better ex lain situations. (use additiani l r es as necessa l: : ` .: E ': ;,;`it ,;. _ T u
Pry Y 1? . �`<g �3) ...... .... a. . u t
b Na mP\ Q• Tied 1 T>u 11 IV I
Reviewer/Inspector Name j ✓��fy
Reviewer/Inspector 5ignatu
"•'� ' ~ ' °•�;;, .�i",;' °f�� ��u �.;l�:i�; , e �e •fir. ��y#•I, V �. [
Date:
3/23/99

Facility Number: Date of Inspection
+.
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ YesXNo
liquid level of lagoon or storage pond with no agitation`!
27. Are there any dead animals not disposed ol' properly within 24 hours? ❑ Yes 4A No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes OiVo
30, Were any major maintenance problems with the ventilation fan(s) noted'! (i.e. broken Can belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ] Yes `,{<No
31. ❑o the animals feed storage bins fail to have appropriate cover? ❑ Yes >9�4o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes -,,,,lu-
itiona omments an or rawings: �t ;.
't a,
3/23/99

! [3 Division of Soil and Water:,Coaservation -'Operation Review. i
r a 13 Division of Soil. rind Winter Conservation-.,CunripIiance.Inspec tion
Vi�isian of Water Quality Compliance
Other Agency - Uprrativn Review ` . I' r & '} •r {
,ka Routine Q Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSNVC review Q Other
Facility Number Date of Inspection
fine or Inspection 4 24 hr. (hh:mm)
© Permitted ja Certified © Conditionally Certified © Registered Not U erational Date Last Operated:
Farm Name: , r .......................
...........�..'E�1�.....�1:.�•ii�-R-:l..a.�i.�a�.-.................................................... County: ... `�....SJ.>¢C�r� �.............................
OwnerName : ................. .................................. ..................... ....................................... ............ Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:..................................................
Mailing Address; ............................. .......................
................. ..................................... I.......... ...................................................................................I. .........................
Onsite Representative: 5,�� Integrator-.
Certified Operator: ....................................... _ .......... ............................................................. Operator Certification Number:..........................................
Location of Farm:
A
.......................................•--................ ...........
Latitude a =_ 44 Longitude •
Design Current' Design Current Resign Current
Swine Capacity Population Poultry Ca acit .,Po ulation .,. Cattle Capacity Po ulation:
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[]'Gilts,
❑ Boars
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other I'
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Arca
Holding Ponds 1 Solid Traps 10 No Liquid Waste Management System
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
b. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ)
c. If discharge is observed. what is the estimated flow in gallmin'?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ...........1....................................................................................... ••.......................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes P No
❑ Yes 0 No
❑ Yes jPf No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes JV No
Structure fi
❑ Yes 4� No
Continued on back
3/23/99

Facility'Number: 3Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
Closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify IIWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenaricelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Appliratinn
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type G , 5hc4LA%,
MEN
13. Do the receiving crops differ with those desigru/ed in the Certified Animal Waste Management Plan (CAWMP)?
14. a] Dues the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel 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 rail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZNo
❑ Yes VNo
❑ Yes ;3'f4o
❑ Yes 1PT10
❑ Yes ENo
❑ Yes �o
❑ Yes ZVo
❑ Yes Q�No
❑ Yes 12rNo
❑ Yes ;?�No
❑ Yes tE!(No
❑ Yes )2"No
❑ Yes JzNo
❑ Yes �No
❑ Yes o
❑ YesNo
❑ Yes —KNO
❑ Yes 21"No
❑ Yes ZNo
❑ Yes PIKo
❑ Yes PIKO
yi¢l;aigtis;oiiecepte wire �irzte4dtrrtrig this•�isit;; Yoh witi;eetriye llv t`utr ;
c6ires 6Mence: abu' tf this .visit. . .
Comments (refer to gtiestiorn #): Expla':n any YES answers an or'any recommendations or. any other s gzitii�ients!'
Use drawings of facility to better explain situutions..(use' additional pages as;necessary
J !&O uT, t4gOs,,Q j0,.1.7.4c.ic- ►iA(,c t I yr V'��xy .!AL,L 44a r,3'1ALL_ �4oIre
t'fo`r Ufa lLe a tira XSCP up es—PDXrs r-n
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Reviewer/Ins ector Name
p ,: �s7 J�"r ,. ,/,►jam - q1� �57��'''T,�� lid, �I:'fulir•1;�.#[�� :u'.�::��,u:'
Reviewer/Inspector Signature:
Date: % f z 7
3/23/99

Facility Number: !late of Inspection
Odor Issues
Z\25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below 0/es ❑ 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 RNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )dNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon'? ❑ Yes J;?No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, ctc.) ❑ Yes 'P�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
'IN. Do the flush tanks lack a submerged Call pipe or a permanent/teniporary cover? ❑ Yes 2fNo
Additional Comments and/orDrawings:i
J
3/23/99

❑ ❑
:FDivision of Soil and Water Conservation ether Agencyis€�
Division of Water Quality uF:.. " �''-
.... `.. � :s• .�:� .: �ue,,.,,a.,.e errn...:"'r"'^�.a^yqr».esenrgeFsq�''^....rS..—...i�n...w . ... �. s,: � '�
...............Y.".°n .. .!�l....."....SSy...;.......h• y^.uv»...ns::.m...,,�..,;;,.--e..Quy»,q:-r"WP'".'!?t:!Y:?Y'..c.;slF. ..��F. .... ii :. 3lii.'.::.e. �i� �.. `�..T::Si ..
s
s s
10 lioutine Q Complaint Q Follow-up of DNV(2 inspection O Follow-up of DSWC review, 0 Other
Date of Inspection to
Facility Number 3 E L
Time of Inspection 24 hr. (hh:mm)
M Registered MCertified © Applied for Permit 0 Permitted JE3 Not O eratirrnxl Date Last Operated: ..........................
4A.&j �d✓ County, , Farm Nance:.. i? ........x.�....�fi'Y..^,,,^................................................ ��••�.i..r..ti,................................ .x..
Owner Name: .................. . .......... Rr! .x....................................... Phone No:...t.......................
FacilityContact: .............................................................................. Title:.......................................................... . Phone No:...........................
Mailing Address:.. ��.�a.......�.��.�.�....r,..,�. �l..........Lrti'4 �,±.. r,�^ .... ........................ zs.s.x ....
OnAte Representative:,,.,.S• -� . ..............................
........+.r.!.x~c�............................................... Integratr�rc...�;�c..rCb...�. �..�C.....................
Certified Operator;............................................................................................................... Operator Certification Number:.................
Location of Farm:
Latitude Longitude
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
2, is any discharge observed from any part of the operation? ❑ Yes ER 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 91 No
e. If discharge is observed, what is the estimated flow in gailtnin? h� Al.
•d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes %No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes M No
mai nteuance/improvement?
6. is facility not in compliance with any applicable ,setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [ZNo
7/25/97
Continued on back

f Facility Number: 31 — L
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons,Nolding Ponds, Flush Pits, etc.)
9. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Yes IN No
Structure l Structure 2 Structure 3 Structure Structure 5
Structure 6
Identifier: ........2 ,...............................................................................................................................................................
.... ................
I .......... ....
Freeboard(ft):.................................... .................................... ................................... .................................... ............................i...........................................
10.
Is seepage observed from any of the structures?
❑ Yes
'A No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste AVRllcatiOn
14.
Is there physical evidence of over application?
❑ Yes
t&No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..)sir �.� u.S�-a................... ................ .............................................. ..............................................................
16,
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
19No
17.
Does the facility have a lack of adequate acreage for land application?
® Yes
❑ No
18.
Does the receiving crop need improvement?
❑ Yes
O No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20,
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
12 No
22.
Does record keeping need improvement?
❑ Yes
H No
For
CertifiedQLrennlitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
IN No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
®' No
0• No:violations or deFcienCie's were itate&during this'. visit'., :You.-*vi11 receive, no ftirttier ' •
correspbadehce aihoiit this:visit:• :. -.
.. .. •e: . e�: 'e" i e»;. '�:: .: ?f:;^'•sri ��:Fl"' :� ib:::..�•::: t'.:... zl.:FF51:....:.�:;ei: �!ir. y i
...•�»:ln:¢':,:i+�. .«n: .i.. ,: .. .... quest
Lath ments.(refer-to question #): ,;Expialn.any•:XE 811i1swers andlor, aaL recoin aWndattnns nr:an nth er.cttmmlena'J ' j ,i
P FFFF.' i• e S� 'd • • • • tF b— $� t��»t °Y.. "" �r. xr�F � ' EE`
[Jseidirawirigs of facility to better'explairi srtuatrsirl�, (use addltli}nill;pages as.neces5ttry : ; °' l'FS a xy
.. 1 ... , e
I . 3!'.. ... .iT t.�$��:Ee fi g3I; ���� .sNtF
t�- t t-%4 e.-r -t~ b-0 o�-r
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7125197
--+I••i �.. - .ir.. .e;�."` i �.; ' 1!F3"'..°°.i» :�:...., a.. E,...... S, _! ';1114'j' ss'gg(^•SS Sw...»au!(: ::: .::E
Reviewer/Ins actor Itiarzrc fs' ,; ,.
p t
Reviewer/Inspector Signature: AR Date:
V

•
�J
Site Requires Immediate Attention: �j
FacilityNo. al - ¢18
DIVISION OF ENVIRONMENTAL MANAGEMENT
'ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 ~ 0 , 1995
Time: l 3-vS
Farm Name/Owner: STV— \1 G k't r�� t �7 c►- dr •Z
Mailing Address: - RZ' 1 x t 31 A 1Ce.!-J A a c v r- -t$ 3 44�
County:
Integrator:----csus -Phone:
On Site Representative: Phone: �t 5 ►) Zcit - q�Ar 3 9
Physical Address/Location: � �[� 1 Sal o • x--`• �- �-�., r►--
Type of Operation: Swine `'- Poultry , Cattle
Design Capacity: ) 6 o Number of Animals on Site: C�.c7 N�� rzY
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 64- ` I." Longitude: ��' _Sa ' 171 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Ye r No Actual Freeboard: Ft. Inches
'Was any seepage observed from the lagoons)? Yes oro�Nas any erosion observed? Yes orQ-4a)
Is adequate land available for spray? (ye3or No Is the cover crop adequate? Yes or No
Crop(s) being -utilized: 5M&_!!04
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. Yes r No'
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ok
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 -tirade devices? Yes 0(sl'
If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
ci
cc: Facility Assessment Unit
Use Attachments if Needed.