310570_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: om Hance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint (:) Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: C �: Region:
Farm Nara
r � � vc� �itrcaaC Owner Email:
r
Owner Na e: - 114 10 7 7 - ele— k" r1 r`h^J_Qi �' Phone:
Mailing Address:
Physical Address: r�
Facility Contact: f`6q9j90%_ ?oO Qje w,0,4 Title: 61-efelt7-ee'___� Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity P.—ORM
can to Finish
ltry
Layer
Design Current
Capacity Pop.
C•attl
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Design C►urrent
Ca aci I;o ,
Daia Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
_"FA d Cow
Other
OtherI
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CS -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [—]No
[—]Yes P.No
❑ Yes fil-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - [) Ds ection:17
= Waste Collection & Treatment
.' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z^
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F�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
Q No
❑ NA
❑ NE
S. 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
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
l I. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q 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
/0-1-
12. Crop Type(s): �r�`�4 5z-'-c-i
13. Soil Type(s):d�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z[No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Z[ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
f�J_No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
D 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 [ANo ❑ NA ❑ WE
❑ 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? El Yes � No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f�JNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: -- /
,j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes B_No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes figNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other;
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 0,No ❑ NA ❑ NE
❑ Yes [5 No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes ENo
❑ Yes EqNo
❑ Yes [2[-,bLo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #) Eiiplint aoyYES°answer`s and/or any additional recomnitendatioos or any other com`tnents.
Use drawings,�gf faciliity to better explain situations, ( addtlonal a es as necessa
use P g r3')
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
' Phone: "303-0L5-1
Date:
21412015
Page 3 of 3

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [ / Arrival Time: Departure Time: County: D I Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Aim P&I.e
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Title:
Phone: `l
Integrator:`,
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
et Poultry C*apacity Pop.
Design C«urcent
Cattle Capacity Pop.
ean to Finish
p
La er
Dai Cow
rNFjeeder
ean to Feeder
Non -La er
Dai Calf
to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr, P,ouitci IP,o .
Dry Cow
iry
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow'
Other
Other
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J�+No ❑ NA ❑ NE
❑ Yes
'�] No
❑ NA
❑ NE
❑ Yes
O'No
❑ NA
❑ NE
[:]Yes Z No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

FFacility Number: — j Date of Inspection
.Vaste Collection & Treatment J 7� ✓
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identif er: j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
;3No
❑ 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
�ZNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
LNo
❑ 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
PNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Iallo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
OfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;qNo
❑ NA
❑ NE
a g;. -_;"�,
'Comments (refer to questton:#) Eacplain any YE5_answers and/or any recommendations ooth r aityer�coiriments
K
:Use drawengs,�of facili to iietter ex laiwAtuations (use �addihonal � acres as necessa )
.t p l p br.
AL
all,
3118
Reviewerlinspector Name _a F Phone: 1G�2w
Reviewer/Inspector Signature: Date: ,�
r 4128104 Continued
u6cc Uj✓

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: R
fl / ` Arrival Time: ,` Departure Time: County: Region: "
/
Farm Named. �f�h� �/� J/}�--�^ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: azzsz
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: i2Z/a
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current Design Current Design
Pop. Wet Poultr)' Capacity Pap. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
I INon-Layer
I Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Design Current Dry Cow
De. P■Dolt . Ca aci P,op Non -Da'
Farrow to Finish
ILavers
I
113eef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ,[Ej No ❑ NA ❑ NE
❑ Yes .fNo
[:]Yes Ef'No
❑ Yes 0 No
❑ Yes Ef No
[:]Yes 12�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility Number: -ax IDate of Inspection: - /
Waste Collection & Treatment
4. Is -storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [�f`No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r�
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 t 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 2] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �3 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 .n No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes 1:�.No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes gNo ❑ 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 4ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑.Vo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:�'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VJ 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 fNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: ' Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes E] No ❑ NA ❑ NE
-.
25. Is'the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,E� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes .EjNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �no ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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? ❑ Yes Ej No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EfNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E!j No ❑ NA ❑ NE
❑ Yes jZrNo ❑ NA ❑ NE
❑ Yes fj No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
of
y to better expl.
YV
l� s�
Reviewer/Inspector Name:
situations (use additional pages as necessary).
7 V- /-G'��ds /60,�f"50001"',
Phone:
Reviewer/inspector Signature: _/C�/ �� �� Date:
Page 3 of 3
I

Type of Visit: QCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 21outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure r Departure Time: County�iRegion:[
Farm Name:%C'0iOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Arz_�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: &' ZeK
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design Current Design
Capacity Pop. Cattle Capacity
Current
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dt. Pooult ,
Layers
Dairy Heifer
Design Current Dry Cow
C•.a aci P,o P. Non -Dairy
Beef Stocker
d�:
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
NJ
Qthe
Other
Turkeys
urkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse, impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 21"No ❑ NA ❑ NE
[:]Yes Ej No
❑ Yes EfNo
❑ Yes 4No
❑ Yes o
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 Y+ 21412011 Continued

1 10
lFacHity Number: - Date of Inspection:
Waste Collection & Treatment
4.. s,storZge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes dNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
_L2�,No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes /Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ; No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes C2'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 r—l"o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes OrNo
❑ NA
❑ NE
maintenance or improvement? '
I L Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes jErNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
7�``�VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes P 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.
to
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ Yes �1 o ❑ NA ❑ NE
f5. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes La"Ro ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ;2-No
❑ Yes P3'No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes )23-No ❑ NA ❑ NE
❑ Yes �No . ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ff No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [] Yes eNo ❑ NA ❑ NE
Reviewer/inspector Signature: Date:
Page 3 of 3 21412011

r{
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10"Aoutine O Complaint O Follow up O Referral (:)Emergency 0 Other ❑ Denied Access
Date of Visit: /L /3 Arrival Time: �0. ot� Departure Time: County: / Region: "� �l�
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: L�f cr,F�c ✓r /' C�iZ-�-;��.
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: �/fZZ
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = u Longitude: = ° [� g
Design ,Current �Destgu Current:, r DesigpmmCuen
Swore Capaci Po ulation ry Ca act Po Mahon Cattle .Ca aci Po Mahon`"
ty. P Wet Poult P, h' P P ham_ P _ x� .R_h...
❑ Wean to Finish 10 Layer g ❑ Dairy Cow
El Wean to Feeder ❑ Non -Layer " El Dairy Calf
r
❑ Feeder to Finish ❑ DairyHeifer
❑ Farrow to Wean k Dry Poultry, ❑ D Cow
E ❑ Farrow to Feeder ' '" "'"' El Non -Dairy
Z ElFarrow to Finish & El Layers
❑ Beef Stocker
El Gilts "❑Non -Layers -; ❑ Beef Feeder
❑ Boars ❑Pullets
❑Beef Brood Cowl
5 : ❑ Turkeys
"OtherZZ. � ❑ TurkeyPouets
❑ Other ❑ Other Numerof 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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes PKNo
❑ Yes o
❑ NA
ElNE
❑Yes 2No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

4 Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JdNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Plo ❑ 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 F!�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ;rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ;2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2'No
❑ NA
❑ NE
Use drawin(sefer to of facii nestion,ft -Explain any to better explain. situations a swers� and/or use addittonala ayrecoes asmm essaations or any other comments
g ty p ( p g ry.)
Reviewer/inspector Name ! -
Phone:AR
7 3(
Reviewer[Inspector Signature:
Date:
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 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U110 ❑ NA ❑ NE
/ ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ElSoil Analysis ElWaste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes WNo
❑ 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 XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ///<o
[INA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes EYNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 0No
❑ 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 04o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes dNo
❑ NA
❑ NE
%At Cry ee6 (,j Ap
w r�-
/o����v
-7,P- w v
A //0
I Z28/04

-0-Division of Water Quality
Facility NumberN �2 ] O Division of Soil and Water Conservation
O Other Agency
Type of Visit 42 ~-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10111outine 0 Complaint - 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % Arrival Time: Departure Time: E� County: Region: 6 // L.A
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �^
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
P,honne No:
Integrator• ,� Z4LX4
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Cattle
Design Current.
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife
EFDry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes :No ❑ NA ❑ NE
El Yes L' I No ❑ NA ❑ NE
12128104 Continued

}
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes I
El NA El NE
a, If yes, is waste level into the structural freeboard?
❑ Yes PNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J2NO
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes j2 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat; notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ETNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes 0 No
El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [�io
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P No
❑ NA ElNE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 2'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes J2-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑'lslo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �][ Ale �0 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):
_�vm d- %eCo..,-c>S
A
5U DC,,/',
Reviewer/inspector Name / Phone:
Reviewer/Inspector Signature: Date: 7
1212810 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 El NA ❑ NE
the appropiElEl❑ Design El ❑Other
ate box. WUp Checklists // 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 I" 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
[A-VNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Ye(
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
To
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW -MP?
❑ Yes
�
o
ZfWNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
JVNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'VNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Vj No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VN o
❑ NA
❑ NE
Additional Comments and/or Drawings:
i� LAse d Apr !
--, u t e
-71-1/0
60
74
1�
� s y
L a Do r! a ff �t S bee, m �✓,eo�
91U� 3 5-
12,QV04

Facility Number
Date of Visit: I Zd bZ Time:
10 0
Not OiDerational 0 Below Threshold
® Permitted C��ef%rtiffied 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm dame: AIA 1 611,1f1A i FYN` County: euQ/I�t _
Owner Name: t e— ram/ _. Phone No:
Mailing Address:
Facility Contact: //��jj Title: Phone No:
Onsite Representative: e/l 4 er- Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • 6
Design
Current Design CurrenE Design Current
Swine Ca achy
P,a ulaHon Ploultfy Ca aci P,o Wation Cattle Ca acity P.o ulation
❑ Wean to Feeder
❑ Layer ❑ Dairy
Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
❑Other
Total Design Capacity
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 -spray Field Area
Holding Ponds 1 Solid Traps
❑ No Liquid Waste Management System
har es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
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 gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes El No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes %No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Freeboard (inches):
05103101 Continued

i
1
Facility Number: 1 —�1D Date of Inspection Z zD 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 ❑ Yes ONo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PTNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,9No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes &No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �[$No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes C'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [XNo
5100

Facility Number: — d Date of Inspection Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes CffNo
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes jgNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[NNo
11.
Is there evidence of over application? ❑ Excessive Ponding El PAN Overload
ElYes
[2 No
12.
S❑I _Hydraulic
Crop type //l1y/ll� � 5/� _5076// 4a,47
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
P] No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ONo
b) Does the facility need a wettable acre determination?
❑ Yes
6 No
c) This facility is pended for a wettable acre determination?
❑ Yes
VkNo
15.
Does the receiving crop need improvement?
❑ Yes
CKNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
CKNo
Reaulred Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KANo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
allo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
JR No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CgNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ER No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
DjNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
allo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
,M No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
DR No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to quests©n #) 'Explain anyYES'answers and/or Tiny recommeiidatlnris'.or any other c©mments -'` r
g,
Use di awm s.of fiicdi to b
ty titter explain.situations (use
r ❑ Field C> k
additional pages as necessary) Copy ❑Final Notes
�
...
.:�.
v�
e°I� �L5 !1P[/t 1jJrf` �1�/
��� //sir ��/ 1�J7at8! �/�'ct� i1�,a'� SO.i►��
'or111!111911'fJ �imr� 44 ! ,
w
Reviewer/Inspector Name I
ReviewerAnspector Signature:
Date:
05103101 z All
Continued

r..
r, Vivisiomof
rv,sion of Water uah 3
Q ty
Sod and -Water .. s� Ater Conservation
Agency
t
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ARoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
FDate or Visit: I �� Time: `3 G O Printed on: 7/21/2000
acility Number �
0 Not Operational 0 Below Threshold
Permitted © Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ... County: D!.........................................................
OwnerName : ..................................... .............. ........................................................................ Phone No: ....................... ................. .............. .................................
FacilityContact:.............................................................................. Title:................................................................ Phone No: .......... :........................ ................
MailingAddress: ....................................................................................... ..........-................................................................................. ..........................
Onsite Representative: ..��� —4... ,' , integrator:..... .-.-...
.............................. ......
Certified Operator: ......... .................................... Operator Certification Number:....--.--........
Location of Farm:
WC-4 "14 cv S� m 9-41--a Sy, is 15.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C�• ° L= Longitude ' ° 44
Design Current. Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Weeder to Finish (jQ ❑ Non -Layer I I IFI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons j ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps I ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Magoon ❑ Spray Field ❑ Other
a. If discharge is obscrved; was the conveyance man-made ❑ Yes ❑ No
b. If discharge it observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. 11' discharge is observed. what is the estimated flOW in gal/min''
d. Dues discharge bypass a lagoon systent:' (If yes, notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes dNo
Structure I Structure; 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier..................................................... ...........................
Freeboard (inches):
5100 Continued on back

Facility Number:2(-15=1Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q'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 MNo
(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 IqNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes DZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes CTNo
Waste application
10. Are there any buffers that need maintenance/improvement? ❑ Yes R No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes QNo
12. Crop type--
13. Do the receiving crops differ with those designated 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 O No
c) This facility is pended for a wettable acre determination? ❑ Yes b No
15. Does the receiving crop need improvement? ❑ Yes kTNo -
16. Is there a lack of adequate waste application equipment? ❑ Yes ZNo
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑Yes
IvI No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
_MNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
NNo
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes kNo
23. Did Reviewer/Inspector fail to discuss reviewhrispection with on -site representative? ❑ Yes KNo
24, Does facility require a follow-up visit by same agency? ❑ Yes D�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
0;Rio violaiiq ... cle#iciencies mere bored ilitritig 4his:visit' - Yoit will -receive do further ;
- ctiriesoorideic' e: ab' ' i this Nisit. ::::::::::::::::::::::::::::::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
CUse drawings of facility to better explain situations. (use additional pages as necessary): (l
i c�,rs- ` ��i��-_t �-•.� � �ca�e �is �se. � e� -�,
ova-�4,
Reviewer/inspector Flame
Reviewer/inspector Signature:
Q 3qS--3�0Q X a.a-c
Date: H--00 5100

Facility Number: 3 — Date of inspection M 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 ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 14No
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 11
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [� No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �b No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes EkNo
S/00

- ...
0 Division of Soil :a-nd*zWat'erCo-n's-e'rvation--- Operation Review
ivision of Water Quality t--jc oQa'tio'n-
CoTp4awcelffisi3 Division of S6&and 'Water Conservi&�4nsP!ction
r as
110ther Agency Operation ReMeW
Routine
Follow-up of DWO in
of DSWC review 0 Other
Date of Inspection I V—/ =
Facility Number Time of In . spectioti I lVeC7 124 hr. (hh:mm)
0 Permitted Certified 13 Conditionally Certified 13 Registered 10 Not O erational Date Last Operated: ........ ­ ...............
Farm Name: ....... VAIrIVIV 1� .. :_ P..!Y4 FA-)e-4? ................... County: ........ 7UR
........... ................
Owner Name:...... ti, C . ........
Phone No: ......... q1 ................
...................................
FacilityContact: ......... . ........................................... Title- ............................. Phone No: .................... ..............................
Mailing Address: .........
.... 1.4- ....................... ZS
A. ...... .........................................................
14 Onsite Representative: ........ .................... Integrator: ........ . ...... ...................
Certified Operator: ........ .............. Operator Certification Number: ..... M6
... . ......... j ...............
Location of Farm:
51PIA-0WIM6 E
Latitude Longitude
D Current Design Design Current-.- esign Current
Swine_­�-
Capacity Population poultry.-,-
Capacity. Population Cattle.
Capacity Populatiow-C
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
'V00
JE1 Non -Layer
0 Non -Dairy
❑ Farrow to Wean
-'0
Farrow to Feeder
❑Other
❑Farrow to Finish
T6tal Design Capacity
*0
[I Gilts
❑Boars
Tot at.SSLW
Subsurface Drains Present ❑Lagoon Area ❑IE] Spra F�eid Area
Numberof Lagoons ❑SU Me
MoldidaTofids / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [] Lagoon [] Spray Field E] Other
0
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is -the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway
Structure I
Identifier:
Freeboard (inches): ......... ................
Structure 2 Structure 3 Structure 4
Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/99
0 Yes 4NO
E] Yes C] No
El Yes C1 No
❑ Yes [-] No
❑ Yes ;(No
El Yes MNo
0�
E] Yes XNo
Structure 6
........ ........ I ....... .............
❑ Yes XNo
Continued on back

Facility Number: 51 Date of Inspection
'6. Are there structures on -site which are not properly addressed and/or managed through a waste management or -
closure plan? ❑Yes XNo
(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 A No
S. Does any part of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes JKNo
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 maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12_
/
Crop type "CAes_ f106rltG- Bel AldhA 0UP-ieSi��}�
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
K
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
YNo
b) Does the facility need a wettable acre determination?
❑ Yes'J
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15_
Does the receiving crop need improvement?
❑ Yes
No
16_
Is there a lack of adequate waste application equipment?
❑ Yes
No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available? '
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ief WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22_
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
yft�Aq
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
4 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ao No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
jo No
Rio yii�latiQris:or deficiencies were noted i�uriitg this:visit: • You ;WH1-eeeeiye Rio; further
cOrreS»OildeHee: 7O1it t}I1S Visit_ ' : ' : : ' : : ' . : . . : ' . : . ' : : ..... . ' . ' . . ' . . . ' . . . . . . . '
Comments {refer to question #) Explain any YES answers and/or. any recommendatsons or any other comments =
Use drawings of facility to better explain situations (use adclidonal pages as necessary)
1 rauu LActel (7_1AJ ROOF) OkZ4 tP & MOXXIcAWO S OOr or—
t4q" /J .'
dk� 7k e t� 00rf AS 11/5r)eO r
I Reviewer/Inspector Name
�
TT
Reviewer/Inspector Signature: lax,41-r/.��.-�-� - Date: / % % 7111
F,
3/23/99

Fa�illty Number: 3 — S70 I)ate of Inspection 7! 1 ]
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes JvNo
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 XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Y,(�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes �� No
lAdditidnAlzC6miiieiitsatid/,or--Drawings:.'
a
ds 6� eeil;,< (Vat '14)/rmt erok
a
3/23/99

n 3 Division of Soil and Water Conservation ❑ Other Agency t
�Ej Division of Water Quality x
Routine O Complaint, O Follow-up of DW2 ins ection O Follow-u of DSWC review O Other
Date of Inspection 1 q$
Facility Number Time of Inspection 1313ca 24 hr. (hh:mm)
13 Registered f9 Certified © Applied for Permit © Permitted 113 Not Operational Date Last Operated:
Farm Name: .Nk�P. l........ n.,t.ni �y County:..........:r..............................................................
Owner Name: ......................�.1.1 ;.... - ........... L yr - Phone No: `�� �.. `3 -! q.u.1 ............................................
.....
FacilityContact: .......................................... .......................:...: Title:...-----........................................................ Phone No:......-----........................................
MailingAddress:.........?a o.....&(....... 1. � ................:.:..................................I.................... ufA................ .............................. S s4.........
Onsite Representative: ............l.r?Xa�t)Integratcir:.-........ Ltr k.......�U-4'{fh..................................... ..............-............
Certified Operator:.............................................................................................................. Operator Certification Number:........................ .................
Location of Farm:
...................Si..f r.........5..............�.....r..Z...x?�t�.G�....'SCS%. 0: ....5......l.�i�1...................k..........Q..:QkLfla................... A,Itel�.
tn.......Ui.............................................. ................................................... ............................................................................................. .....................
Latitude Longitude �• ��r
;' Design " Current --Design, Current Design _Current
Swine,',, ,Capacity-PopulationPoultry Capacity Population Cattle ="' Capacity `Population
❑ Wean to Feeder
Feeder to Finish
CIQD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I 1 10 Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other:
Total DeA n Ca adt °$
p _ Y 9.
Toial SSLW
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
10 No
2.
Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[,�}No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
M No
c. If discharge is observed, what"is the estimated flow in gal/min?
hLjA
-T
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
0 No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
PNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
j8 No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
�No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
\� 7.
Did the facility fail to have a certified operator in responsible charge?
❑'Yes
/fg No
7/25/97
Continued on back

Facility Number:
e
S. Are there lagoons or storage ponds on site which need to be properly closed'?
Cl Yes
No
Structures fLagoons,Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Cl Yes.
No
Structure I Structure. 2 Structure 3 Structure 4 Structure
Structure
6
Identifier:
, `
Freeboard(ft). ............. ` .-A ........... .................................... ..... ................... .......... .......... .......................... ................................ ........................................
10. Is seepage observed from any of the structures?
❑ Yes
[XNo
1 I. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
(� No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers`?
❑ Yes
[j No
Waste :Application
14. Is there physical evidence of over application'?
❑ Yes
0 No
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................ 4.Y..Y�!11 �..........................`1i'` �.�.....Cd'! ia!�........._............. ................................ .............................................
I—-...............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
{ { No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
1� No
18. Does the receiving crop need improvement?
WYes
[11 No
19. Is there a lack of available waste application equipment?
❑ Yes
VQ 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
M No
22. Does record keeping need improvement?
iA Yes
❑ No
For Certified or Permitted Facilities-nply
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
(8 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
12No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
0 No
0 No violation's or deficiencies were noted- during this.visit..You.will receive no further
correspondence about this:visit:•:
Commentsy'(refef,'to question.#): Explain any YES answers and/or"any recoi>nmendati4ns-or any other comments � ,
tjw_drawings o facility to better explain Situations. -(use additional pages as. necessary}.
1�• �w.�t �;�r Si -add �e inner/o� Ott_, •or_R,s of �o•�n�ti shoo)
loc t owt� or 5?vl10v�i►,ove dull(,
i's. te'rM t , C-ro} SkA lie
zZ . rr a�oor. ries ;gr. i r��a • �' a,r� � �'�' � ��� � on t�. ti, � S ���,� � `b� N! ; � �
r.( Lv, ,
7/25197
Reviewer/Inspector Name '•�� (,t,ttyn "
Reviewer/Inspector Signature: Date: /

10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number '
Time of inspection 111 10 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
0 Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: L�. 1. n..v _ i.x, �n.i >r`q� _Fo- ! ,•�•.. _.... _..... ...... County:ar�.. ..........._...... w..., �'i�.t
Land Owner Name•.J ........._...
...� �.�..L.�'�_..�..�.. ......................_........ Phone 1�'0: _�.. a �.�. �...�.9 �'i.2.�.�
Facility Conctact:..................... ....._..... Title: .... Phone No:
Mailing Address: Q.....o . ��i. _.... , .... _.................... _........ ...sue �..t.l.� �.R� ...1.�...._._...._ ....� 5.. $..
Onsite Representative:Integrator: _1-A- act.
Certified Operator: �..._ .�..���. _.... a f5.... r ....__.... _... Operator Certification Number: �r .
Location of Farm:
.Qr.�._.�..a...s,.�----S.i.tl.�e..._�....S..L,.,.l.$'..Q..l..}....S,.k.l1.. ...... ..... �.v�a...... �.s...t.�1..»....sox.i..t=.k�......tS..P�.l.$ .�_ .,,.---.F.o..r.a-�...... 4?
.�..O.ta�...�a �..... ... �._.. Via.... ...li...
Latitude ®' �� " Longitude* ®�
Type of Operation and Design Capacityf� Wiest n CurrenE ma
Design �Curre at Design` Current xM.
v art S , ,
Swine -�Ca act Po iila4on .poultry=. �_ Ca act Po utatian . s Cattle _Ca act Pp ulatldi v
❑ Wean to Feeder �❑ La ❑ Da
® Feeder to Finish o ❑ Non -Layer ❑ Non-Dair
9 Farrow to Weank
Farrow to FeederTotalDesigII Capacity Do ' x
Farrow Finish
.�. w t
Totat LW 1-jo 0
r l
❑ OtherFym
Number of Iagoon§ /Holding Pattds ❑ Subsurface Drains Present
i t� ❑ Lagoon Area ❑Spray Field Area
ene a
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface A -later? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes E "No
❑ Yes M No
❑ Yes q No
*,� I' -A
❑ Yes E,No
❑ Yes 19 No
❑ Yes K No
❑ Yes Wo
Continued on back
Iert.

Facility Number •-3�..._. —...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures ((Lagoon. and/or Iloldina Pond.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes ®..No
❑ Yes 19 No
❑ Yes I& No
❑ Yes @�No
Structure 5 Structure 6
Waste, Application
14. Is there physical evidence of over application?
(If in excess of�WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............ ......... .......... _....... ......... ......... __.... .._ .... ............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20.. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For -Certified— Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWNIP?
24. Does record keeping need improvement?
❑ Yes 9No
❑ Yes IR No
.Yes ❑ No
❑ Yes C5 No
❑ Yes J.No
❑ Yes ® No
❑ Yes 19 No
❑ Yes 19 No
❑ Yes KNo
❑ Yes ® No
❑ Yes ® No
❑ Yes 0 No
❑ Yes J,No
® Yes ❑ No
Comments (refer to quest�on�#1) Explain any YES answers andlor any recommendations or any other comments �,�
Use drawirigs,of facihty to better explain srtuations.'(use addjtionai:pagesas necessary) � ��� � � ,�
...
-
12. P-t -,..-s re. t-"A-s .., o %1 tw w R L i
u w L 1• f i-R_ e
a o n. b +� v-t� i 10 , w
i f Vj e 4
oK - u -�-�
e
l o�
e
f
�S`e ,' 1 S rt..- , L e�
t'•V. V-¢-v-• L--36 L� ,. r 16 0 f
I
r r4, �, UF_ ! c� y e �r a-, -� °� , •
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Reviewer/Inspector Name gar r
Reviewer/Inspector Signature: ,r)L Date: < 0
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cc: Division of Water Ouality. Water Ouality Section. Facilitv Assessment Unit 4130/97

Site Requires Immediate Attention:
Facility No. � i z7-FO
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: / 2 S5
Farm Name/Owner: JL�-t u�a 1 n ti M 11-4rA / /l e-;' 61 car e,44 j . ,.
Mailing Address:
County: n� ok
Integrator: i k4gp�+y - Phone: __ -Kg dof D Fr9 a 11_ I
On Site Representative: i cK r-r`Phone:
Physical Address/Location: lVCS P__ tkV I �(Aw t ►nip
Type of Operation: Swine Poultry Cattle
Design Capacity:. 100 h �ts�; Number of Animals on Site: 5 O 0 ...
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �_' 54 Longitude: '7') Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) OC or No Actual Freeboard:.__-LFt._ Inches
Was any seepage observed from the Iagoon(s)? Yes or.No Was: any erosion observed? Yes or No
Is adequate land available for spray? e>r No Is the cover crop adequate?.(5 or No
Crop(s) being utilized: (� o wtsrrr ��
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ? reor No
--100 Feet from Wells? use or No '
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 1€e If Yes, Please Explain.
Does the facility maintain adequate. waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? Yes or
Additional Comments: r
Inspector Name
Signature T
cc: Facility Assessment Unit Use Attachments if Needed_