310595_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quaff

Type of Visit: QrCom Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I /� Arrival Time: l 7 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Carrent Des�n Carrent Design
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
I jNon-Layer
I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
D . P,©nl Ga aci P,o Non-Dai
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Furke s
Turkey Poults
Other
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Fe o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: 2 7
V�aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej 1Ve ❑ 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): (V L1
5. Are there any immediate threats to the integrity of any of the structures observed?
es
❑ 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
❑ No ❑ NA
01NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA
[]'<E
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes ❑ No ❑ NA 0-KE
❑ Yes [:]No ❑ NA NE
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
❑ 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):
�NE
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA Cj NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑- i1�E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA Eg-N19—
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 [ " -E—
❑ Yes ❑ No ❑ NA ❑, E
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
❑ No
❑ NA [_ jXS'
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
f-lRainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
❑ No
❑ NA ❑.NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []No ❑ NA [A 1�E
Page 2 of 3 21412015 Continued

Facil' Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
ICJ "
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No ❑ NA
CJ E
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
E3-<E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No [a'NAS
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [] No ❑ NA
/
�
�E
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No ❑ NA
I,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No ❑ NA
ATE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
6-Yes ❑ No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �j`No[j NA
❑ NE
lComme.1its-(refer to.questiou,#). E plain any YF.S a'flswers and/or any,gaddrhonai`reeornmendations or any3other commenbk
:. '
Use drawings of,faciLty to better explain 5ituatioos ase additaona
... f. "� Pa�es,as necessarJ) tll ,lii
0
w
0,1 v, zri
e I r
�h , r�•
M /_9
.c e 5 0" e (,A �r_ 1'.0 tl .
Reviewerhnspector Name:
Reviewer/inspector Signature:
Page 3 of 3
pig po c� is�d1 Phone:
.� Date: L 1 7
21412015

Type of Visit 39,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit '�(Routine 0 Complaint O follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I oil
13 \ / 1 Arrival Time: Ll�.0 Departure Time: County: U/ V Region:
Farm Name: J m E S �� ► O 1— A �� Owner Email:
al t9 - U
Owner Name: m� S L_.� �� %td� Phone' 910 - 520 -14 4o ca
Mailing Address: ' 0 ' ?_-jox 44zs f?W 1 / ' C� 9
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = = Longitude: = ° = , [= It
Design Current
Design Current
Design C►urrent
Swine Capacity Population
Wet Poultry Capacity Population
C►attle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
JEI Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gi1ts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowi
❑ Turkeys
O#her
❑ Turkey Poults
❑ Other
JEI Other I
Number of Structures:
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)
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 kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
❑NA
❑NE
El NA
❑NE
El Yes
El No
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
12128104 Continued

;Facility" Number: / —595
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA c ocy4 _
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 314_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo
through a waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
[I NA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA, ONE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes] No ❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 yes X
No [3NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
A
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
❑No
rNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
NA
9NA
ElNE
17, Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
9NA
❑ NE
Comments (refer to question #): Explain any YES answers.andlor any-rec©mniendations or any other comments
UseArawings' of facility to better explain stuations; (use"additionall pages as'necessary)
F4c-1 c_ ol) !- 0r , (1C6N ON ? 1cfL-c> Sc,.w+NE PE [zm! T S/NC E
S(�o►C w� �Y1t,?,. XCW 4A( P o" (U W3P_6 .7--rorv. ! S
�' w .gwtF.cwf- OSOLLr �oss�F3r`c� Qc�Qc�gswC�'�fZo���
ccLosmt6 LAcoc�W w/ WGL_P IF SOw
Reviewer/inspector Name
Reviewer/inspector Signature:
Phone: 1�
Date: ?
Page 2 of 3 12128104
Continued

Facility Number: Date of Inspection 3 /
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 ElYes ElNo ElNA INE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ❑ No []NA XNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ t20 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA U \ 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
❑ NA
NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel 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
kNo
❑ NA
❑ NE
Additional'Comrdents and/or Drawings:._
�lx(w [NE)lcq r ct� I RuE
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: \txsl� Arrival Time: ® Departure Time: County: A/ Region:
Farm Name: JAm�S �� •XGT! FA�Zf1rl __ _ _ Owner Entail•
OwnerName: _�AMG_5' �XON Phone:
Mailing Address: �• �• goX �ot Ot~ LIk�(-SAL4221rm— coJ / O
Physical Address:
Facility Contact: ` Title:
Onsite Representative: / 1M At D I X 6AI
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = i 0 « Longitude: = ° = d =
Design Current Design
Current Design
Current
Swine
Capacity Population Wet Poultry Capacity
Population Cattle Capacity
Population
❑ Wean to Finish
JE1 Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
❑ Turkeys
Other
❑ Other
of Structures:
qu Turkey Poults
10 Other INumlaer
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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 4,No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
,t
12128104 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:
Snillwav?:
Designed Freeboard (in): _
Observed Freeboard (in):
❑ Yes )ANo El NA El NE
❑ Yes EEEE❑\\No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�,(
El No ❑ NA I(J NE
maintenance/improvement?
V '
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA 'N NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA NE
15. Does the receiving crop and/or land application site need improvement?
❑ 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 .X NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA A NE
;Use drawings of facil►ty to better expI" srfuati ns° (us
.. -.. A..
No NHS + gwUDVi(� <�;Cvhjc
fy�44 btxoN 15 GaL )VG To RWO� Fd?- C!)- AN jrn,gL_ pEal" 1 i
ReviewerAuspector Name Phone:
Reviewer/inspector Signature: Date: 1p9��iQ9
12128104 Continued

�J
Facility Number: j — 57 5 Date of Inspection
V.914164-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
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 El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
O ONE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
114 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
ONE
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
gNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
KNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
� NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel 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 [(No ❑ NA ❑ NE
❑ Yes Cl No N NA ❑ NE
❑ Yes
T( No
❑ NA
❑ NE
❑ Yes
OkNo
❑ NA
❑ NE
❑ Yes
EfVo
❑ NA
❑ NE
❑ Yes [XNo ❑ NA ❑ NE
12128104

Type of Visit oCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Compfaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' '= Arrival Time: DU Departure Time: County: C1N Region:
Farm Name:
Owner Email:
Owner Name: I m LA, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: FF 1 x a%/ Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o [=.
= 61 Longitude: = ° [=], =
Design Current
Design Current
Design Current
Swine C•apaclty Population
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
(0C C7
Q
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
EE11 qrkqy Poults
El Other
❑ Other
Number of Structures:
1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0No
❑ 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
❑ Ni?
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
O-No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

facility Number: 1 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L46c) om
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;&No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 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 El No O�NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No 0 NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No )4NA ❑ 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
❑ No [,NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No [XNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No J4 NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No NA
ElNE
18. Is there a lack of properly operating waste application equipment?
[3Yes
❑ 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):
60!�>6 S c:)N 51 TE 5-1 XICE ti
AL
_ _ C
Reviewer/Inspector Name M Phone: l��i ` 4'(n" 30�
Reviewer/Inspector Signature: Date: /�Jf 'M'
Page 2 of 3 12128104 Continued

Facility Number: 31 Z Date of Inspection
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes hNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
N 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
�SNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
4No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
N NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
,J NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
J�fNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N 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
ErNo
XNA
❑ 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
1XNA
❑ 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
El 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
E)(�o
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number �q
Division of Water Quality
0 Division of Soil and Water Conservation
0. Other Agency
Type of Visit (y7outine
lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: P4&1
Arrival Time: Departure Time: County: �t`1 r L�C-1 Region:
Farm Name: Owner Email:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = g ❑ Longitude: ❑
m
VO
Design, Current Design Current Design Current -;:
Swine Capacity Population . Wet Poultry Capacity Population Cattle Capacity Population
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
&aj
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑.
Other
❑ Layer
" ❑ Dairy Cow
❑ Non -Layer
El Dairy Calf
-- - - -- -
Dry Poultry
El Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El La ers
ElBeef Stocker
El
Non -Layers
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?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
o
❑ Yes
[3/to
❑ NA
❑ NE
El Yes
�To
❑ NA
❑ NE
12128104 Continued

Ficility`Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
16No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: V
Spillway?:
G
Designed Freeboard (in):
Observed Freeboard (in): ;2_3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ON.
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
VNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0No ❑ 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 EJ 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 L`_fNo ❑ 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) i&'SCV(, CLA) J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R(No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
FNo ❑ NA ❑ NE
dNo ❑ NA ❑ NE
2 o ❑NA El NE
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):;
) ij-741,t - 3v .DA`?J . SE N_0 STAT LA) G1 PLAIJ d � LAC,.0-0iJ C L440,(tk V SCN5
cep 6C ,A60dd M6AS()Rej Avcz�G- �N�S �Ghn� St.voG� 5►112VE I mu3 T f3�
06de, ANr) SENT As w&LI,
wL"w vp Tv,c- L-r-r4pG ZGQGn (-P
Reviewer/Inspector Name
Reviewer/Inspector Signature:
n__- 1 ..off
-Is-
kLN Ic u7 _JWeS(_ ?Jebtt s :jA/ s ° oq5
Phonet_ 0 723
Date: 1110.2 6
12128104 Continued

❑ Yes [3"No ❑ NA ❑ NE
Cl Yes 3 No ❑ NA ❑ NE
Facility Number: — Date of Inspection L�111�1�J
Required Records & Documents '' 11
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? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
Ld ,.
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
El Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers
El Annual Certification
❑ Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections L'J Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ef No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
,Z,/Yes
El Yes
❑1 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[Z NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
��
L/J 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
V No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E3'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: I h /lIll Arrival Time: / 6 sS Departure Time: County: 0- 1'/IgL.,.Os ) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: _A ft6S Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = 0 Longitude: ❑ e = 4 = i1
Design Current
Design Current 11 esign, Current
ll,Catt1_e
Swine Capacity Population
Wet Poultry
CapacityPapuEation°
Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Da' Cow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
Feeder to Finish I (,o6+6
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Oti min
❑ Turkey Poults
❑ Other
1
10 Other
Number of Structures:
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
❑ 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
El No
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L�VJ No
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
EXo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Fnility Number: 31 — S4 Date of Inspection !b D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: (A 44ZIJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): }-7
/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L. ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes Rio ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes rJ No ❑ NA ❑ NE
8. Do any oft he stuctures lack adequate markers as required by the permit? El Yes 10 ❑ 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 G No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Cl<o ❑ 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 l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidenceof Wind Drift ❑ Application Outside of Area
12. Crop type(s) rES('y C, C �,l S' W
13. Soil type(s)
D
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
dyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
;j"Noo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El//o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJNo
❑ NA
❑ NE
(s ) fGj GV(_ fs&t,n W: u. N6 I✓o 6 of 12C -OWC .
_CpcZ,mc-YL UAL ddl- (-SAD 1-166-S % yCAZj- V-
Reviewer/Inspector Name 6: , b ..' ` ay Phone: 910 l
Reviewer/Inspector Signature: Date: 1,A,of
12128104 Continued

Facility Number: S Date of Inspection 1J v S
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? If yes, check
the appropriate box. ❑p ❑ Checklists ❑ Design ❑Maps ❑Other
2I. Does record keeping need impr vement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
El Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil A lysis ❑ Waste Transfers El Annual Certification
rainfall[IStocking ❑ 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 E Zo
El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L7 ❑ N ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes El No ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes El No NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 9"14o ,❑l NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No A ❑ 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 WN' - El NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes
D'No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
l—vo
❑ NA
❑ NE
❑ Yes
E'J No
❑ NA
❑ NE
❑ Yes
kJ N
❑ NA
❑ NE
❑ Yes
;LEI No
❑ NA
❑ NE
Additional Comments.and/ot Drawings.
61
12128104

I
Type of Visit 0 7Routine
pliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number j Date of Visit: 5 2$ ot! Time: / 30
���� 0 Not erational O Below Threshold
ClIermitted Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name:. JArM" . Osxo&j Aaft"\ County: DUPE/ ......_.. _..
Owner Name: ___„• ___ „� ., _ , ... _,r
Mailing Address:
Facility Contact: ____ -----Title:
Onsite Representative: •� A r�El W()2X 10 —
Phone No: . •_ _,_
Integrator:
_ Phone No:
GAXIMt_6
Certified Operator. .. w _ Operator Certification Number. _ ,_•, _,
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • " Longitude • 4
'Swine :a
M
UTent .
Wean to Feeder
Layer
Feeder to Finish
p o
❑ Non -Layer
Farrow to Wean
s Other
4
Farrow to Feeder
Farrow to Finish
Z+ D
\.Tilts
Boars
Nkhames & Stream Im acts
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?
—Des
ign Cnrreat
tde Capacety;`'popWahon:`
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 (feeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier- .I...
[:]Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
[:1 No
❑ Yes
t�
;No
[:1Yes
I --]Yes
i
Structure 6
Freeboard (inches): Z
12112103 Continued

Facility Number: — 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 maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �6sco C' ( W 5 nk, Cr %Zo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issnes
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes E�No
❑ Yes E21/No
❑ Yes 2<0
[:]Yes 2<a
❑ Yes 044o
❑ Yes
❑ Yes r
❑ Yes fNo
❑ Yes M'4o
❑ Yes to
❑ Yes 0<0
❑ Yes Wo-
[:1 Yes M o
❑ Yes 0tv o
❑ Yes 2lo
❑ Yes 04o
❑ Yes �o
❑ Field Copy ❑ Final Notes
VP
wI YN 1M 11�7�Mq .1 j
cp R.�S
Awl D
rAr-4v�
UNi'St� -n.� GtJ.
CaAJVA (T O W Q
WQ-E+j LAC'1c$0.I
C'1_6 S s 6LT Da lic ,
Reviewer/Inspector Name g
Reviewer/Inspector Signatuxe:
Date:
1".1-11W 9,019"nuea

Facility',li g12$�atJ umbers --sqr Date of Inspection
t�
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[] No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.)
❑ Yes
940
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
To
❑ 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
No
25_ Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q O
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�,,
(ie/ discharge, freeboard problems, over application)
[I
20
27. Did Reviewer/Inspector fail to discuss reviewimspection with on -site representative?
❑ Yes
21qo—
28. Does facility require a follow-up visit by same agency?
❑ Yes
O N"o
29. Were any additional problems noted which cause noncompliance of the Ccrtified AWMP?
❑ Yes
0N0
NI MES Permitted Facilities
30. is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes To
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
oiislCsesitsmuUor-Drawing s �,
.i�°°.a."'"�ca...,-+�`e,..-�.i: �,,a."^"" ";'-m .a .-.>""�..��_.�...�...`�"
12112103

jX
4 s Iv Dlvrslon of Water Quality tl
Division of Soil and Water Conservathon�
O Other Agency. £ T
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit IV Routine 0 Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
I Facility Number Date of Visit: v Time: 3 ; 0f7 Primed on: 7/21/2000
Not O erational Q Below Threshold
[3 Permitted 0 Certified ❑ C00%nditionally Certified ❑ Registered Date Last Operated oo Above Threshold: ...- . -.
W ..............�.....1� .../5V. .A � . County ........�!!-4 ..'�77
Farm Name: ................... .............................. Z..-.................- (.C/r �Q
OwnerName:....t. 1 ..................... .......... ev—...-.-.-........................ ......... ....... Phone No:.......................................................................................
Facility Contact: ........
Mailing Address: ........
Onsite Representative
Certified Operator:.....
Location 'of Farm:
lots
Phone No:
......................(................
/Yj.. tiiJr Integrator: ../-.-..-....
..................................................................................................... Operator Certification Number: ..........
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• C�` ��� Longitude �• ��«
s Design Current Design Current Design Cthrtpnt
Ca ci PODU . Poultry Ca acii Po ulation Cattle : Ca Po lion
+' Wean to Feeder ❑ Layer ❑ Dairy
w Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
s;� Farrow to Feeder ❑ Other
Farrow to Finish Total Design Cdj)aCity
Gilts
Boars Total SSLW
I�eruf:Lagoons ; Subsu ace Drains P Lagoon pray F A ❑ rf resent Area ❑ S geld rea :
cildwg Pauds i Solhd Traps ' ❑ No Liquid Waste Management System
Discharees & Stream Imyacts
1. Is any discharge observed from any part of the operation? ❑ Yes )?fNo
Discharge originated at:- ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes vNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )xNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..................................................................
Freeboard (inches)-
5/DO Continued on back

t t�
Facility Number: ?) — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
PNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
�No
(If any of questions 4-6 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
0 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�No
Waste Analication/1
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
m No
11. Is there eviden of over appl' atio 9 ❑ Excessive Ponding PAN ❑ Hydraulic Overload
❑ Yes
)ZfNo
12. Crop
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 wettabie acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No.
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
)ZNO
Required 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?
(ie/ WIJP, checklists, design, maps, etc.)
❑ Yes
A, No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q No
l�No
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?
XNo
(ie/ discharge, freeboard problems, over application)
❑ Yes
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes.
#No
�VQ yi a iqt s :er dgf e�e�cies yr re I+Qtec dot k g tri*e 00 fu} tbo
comes deuce: aliotat this v AL .
!8} A Pj6R�h�ocrLrO f�i9✓ /tl�ctJ uJ�sT� �>�
Sw oae Z'C'46 Awe le'-�"o _Der
�—,f- ,O!F�
�F/g,e� BEcA�s�
Reviewer/Inspector Name
Reviewer/InspectorSignature: r Date: R` !fI Q2 _;/00

." . ( k-
Facility Number: Date of Inspection / D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes J 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 VNO
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 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes VNo
Additional omments an or' ravings:
rq)
�N �o �� s o _ _
Z�,�c LF��Ls T
IL
V/u nP�u u
fig 14e-lood AVD S�e��Fz�s GooK�a
5/00

Division of Soil and Water Conservation - Operation Review,
0 Division of Soil�and Water. Conservation -Compliance Inspection _ e
ivision of Water Quality Compliance Inspection a
ther'Agency - Operatian:Review
IRA
Routine Q Com laint Q Follow-u of DWQ ins ection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection -
'Finte cif Inspection 24 hr. (hh:mm)
Permitted Certified Q Conditionally Certified Registered JE3 Not O erational Date Fast Operated:
Farm Name: .-....�............../t1-......-..--..-...... County:.............. /.�--....--......... •L.(f....-........
Owner Name:.......U.� .............. //� �!' --•. ........--. Phone No: ................................
Facility Contact: ............. ....-.............. Title: ................................................................ Phone No:
MailingAddress: ..................................................................................................................... .........................................
Onsite Representative* ........... .......................I.......................... lntcl;rator:..........................r.S..-.............................................
Certified Operator:.......J affus ...........:.... ..1key.......................... Operator Certification Number: .............................. .....
......,
Location of Farm:
�12
t............... -.........................................._....--...-.--.................................-.................. -......... ..-........ I ..................
�
Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish ❑ Non -Layer 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JEJ No Liquid Waste Management System .
Discharges & Stream Imp
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes [�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other '' \`
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. II- discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes No
c- If discharge is observed. what is the estimated flow in galhiiin? %
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any 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? ❑ Yes [(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 '�\\
Identifier:
Freeboard(inches): .......... . .............. .................................... _................................ ........ 1-............. I—, ........ ........... ............... ......... .................... I................
1/6/99 Continued on back

Faci* Number: Date of Inspection
/
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El 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 maintenancehmprovement?.�
Ayes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 0No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes � No
`
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes _Q�40
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes kNNo
12. Crop type Al
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 52�No
b) Does the facility need a wettable acre determination?
❑ Yes NTNo
c) This facility is pended for a wettable acre determination?
❑ Yes RNo
15. Does the receiving crop need improvement?
❑ Yes $No
16. Is there a lack of adequate waste application equipment?
❑ Yes ONO
Required Records & Documents
' 17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes {(No
I& Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes o
N
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes j2No
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 ONO
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 'KNo
24. Does facility require a follow-up visit by same agency?
❑ Yes -_Q 1�o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 1796jo
Nd-vialaiigris pi deficiencies •were hated• during 4bis:visit' • ;Y:oi� will receive Rio t'urthgr ;
i`orrespoxiderr�ce. abbot this :visit: : ;
Comments{refer to question #): Explain any YES answers and/or any recom�endatioas or:anyotiier comments
Use. drawings of facility Wbetter explairi situations (use addtttonal pages asznecessary) Y: x
�f� h
//�j /,id�'ti /S /2eLt1O / -1 �� ?ZJ'riv►•s �uf5 .. S761y'j
}
�, VI1t�._l~�,. d�.�► ua s c.t,4- 10
�=V " MW0I
Reviewer/Inspector Name 4,' ; %'� �/, aJ.
M_ .
Reviewer/Inspector Signature~ p� �/% , ` Dater

Facility Nusnber: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �1Vo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ✓*0
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 @f No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or f�_J
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes I No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [(No
Additional ..,,_. _bmmen_ .and or raw�ngs:.. a,
A,
YMI--tdll� CO
ev,
/ c r
ell
3/23/99

Revised April 20, 1999
,JUSTIFICATION & DOCUMENTATION FOR- MANDATORY WA DETERMINATION
Facility Number _3( - Sg Operation is flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative., t Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name: 5 0,ar,r
Date of site visit: 7 f 2 ! f-`l
--P
Date of most recent WUP: f Z
Annual farm PAN deficit: zzzp pounds
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
VV
Operation pended for we a acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system wlportable pipe;
6, stationary gun system wlpermanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and DJD3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 173, before completing computational table in Part 111).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails -one of the.eligibility
requirements fisted below:
F1 Lack of acreage which resulted in overapplication of wastewater (PAN) on spray
f eld(s) according to farm's last two years -of irrigation Tecords. .
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to.deduct required
buffer/setback acreage; or 25% of total acreage .identified.in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revised April 20, 1999
Facility Number 2i -��9_57
Part Ill. Field by Field Determination
of
75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'.2
TYPE of
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES\
FIELD
%
COMMENTS3
7. 3
G�.s n�tru
Z
<<
f_
1- �
-3- L4
541
I
I
i
I
I
FIELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. if pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBERS - must be clearly delineated on map.
COMMENTS'- back-up fields with CAWMP acFeage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & .1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be -accessible
by irrigation system.
Part IV. Pen ing WA Determinations
P1 Plan lacks following information: nl ruA/ t,,s!- V Ac,41"gE
P2 Plan revision may satisfy 75% rule.based on adequate overall PAN deficit and by
adjusting all field acreage to below 75% use rate
P3 Other (ielin process of installing new irrigation system):
.4T_

Division of Soil and Water Conservation 13Other Agency
Division of Water Quality .
review O Other
Date of Inspection
Facility Number } 5�1 S
Time of Inspection L41
-0 24 hr. (hh:mm)
Registered [A Certified U Applied for Permit E3 Permitted 113 Not Operational Date Last Operated:
Farm Name:........ -.Ar1.XrA&........ %^ ...........DmwA ......... TarloA...................................... County: .... bv+l?n................................................................
Owner Name:......., laves. ........... 0............ ...... llxaR................................................... Phone No: ..... (9.1b)... ....................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: ....... 143.... SOLSIXy....... rmr
.......... ....... ..........................................
Onsite Representative:......... �;.n s t.............b................................................. integrator: .............CC rroai,r..................................................
Certified Operator;._Qu f^ e .................................................. Operator Certification Number;....2!p.f ................
Location of Farm:
Latitude ®•®' ®,, Longitude ®• ®' "
pesip�.: Current
Design Current " "'-Design'--,-, Current'
Y
�- Swme-.{, , = . t . Capacity; Population
,; Poultry Capacity Population
Cattle Capacity Population,
_
❑Wean to Feeder
', ❑Layer
-
❑ Dairy
-
Feeder to Finish
t rij3
❑ Non -Layer
;',
❑ Non -Dairy
❑ Farrow to Wean
-_
❑ Farrow to Feeder
❑ Other
s
❑ Farrow to Finish
"'Total Design Capacity;'- po
n
❑Gilts
�
- Total $SLW/ ' Of Opp
❑ Boars
�m
Number of ions'/ Holding Ponds, ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Feld Area
�8 g
; t
-= ❑ No Liquid Waste Management System
Est r
General
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 Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in-aVmin?
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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 09 No
❑ Yes [� No
❑ Yes ® No
❑ Yes ® No
alk
❑ Yes
[B No
❑ Yes
® No
❑ Yes
[9 No
[l Yes
❑ No
❑ Yes 0 No
'❑ Yes ® No
Continued on back

`- I.
Facility lumber: 3 t — 54'5-
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (lla oohs folding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
...................................................................... .
Freeboard (ft): .......... 1_1...... ..........
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 , Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes W No
❑ Yes KA No
VV
Structure 6
❑ Yes X No
❑ Yes ® No
12.. Do any of the structures need mainlenance/imlrovement•?
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 ;application
14. is there physical evidence of over application?
❑ Yes
® No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type..........ctsu)�...............................WalAk__.......... .................. ............................................. .............
............"......................
.
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
' No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
CANo
20. Does facility require a follow-up visit by same agency?
❑ Yes
[4 No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
r
22. Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility -fail to have a copy of the Animal Waste :Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
No
0 No.violations or deficiencies were noted during this, visit..You will receive no farther
correspondence about this. visit:. . '
Comments;(refei•'to: question.#): Explain any YES. answers and/or any recornmeridations or any.other comments. � � �,,
Use drawiir s.of•facilit{/ to better ez lain situatii:ns.'(iisc additional a cs as necessary
g S p p i�'
, ,
S. L_ewil_s �rcSe� 4to� 1'Wvca.++I4.(8�1Zc�:Se ' Skovlr� �rse corrlet%t� � �ttiW�� tt,Sr.`�ar�e.
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s .au[d bt.-S�xt}cc�. �ros;ar` cr. � n►.rr �cjC� W�.1, aro�mJ �n(�� �c -:4,o ? o-,- 44`tGd
t•. j 6t_%(r.v2j. 5lvd9e J! iOjQV� s��lr3 — cMCcc Cvn�ar� li;s c Y NCkCs por- jjVkP
ZL. w0.s� �I sort Swt�QI.- c,+,J� cs sj%&j1d Veu�� 40, L& wt- aesr� t-,rric��t�{o+� M&t shavlr
ir. Gef�tt[Str1 ��yr�. IRR'z ° i9K-I w.i S)ttlt1
tM4otM, �`1jpr�(� CiA�(rlldeS S�6JI0 `►�
7/25/97
[Re:viewer/Inspector Name
r/Inspector Signature: Date:

•,-
•
❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
IQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC: review 0 Other
Date of Inspection p r
Facility Number �n
Time of Inspection I—I� 24 hr. (hh:mm)
(V Registered [l Certified [l Applied for Permit E3 Permitted 13 Not Operational I Date Last Operated:., ,•,•„
Farm Name: ...... jtrvge. .....w 6.iXax........ 6—County:...... V. ZA..............................................................
Owner Name: .......iA,fmk.$....... W.�.....b.).xf.r..,................................................................ Phone No: ...�:EIe. .fix G:..............................................
FacilityContact:.... . ......... a.;Xar.................................. Title...........owe........................................Phone .........................
MailingAddress: ...... .10..&I...... 2.-Zz............................................................................... LJ.w>iitnt.,...N.G............................................ Z.917? ...........
Onsite Representative:......) S....... .i. kxti............................................................ Integrator: .....�i''DAk........................ ......................................
Certified Operator;.......... .A ,S..... _.---f�.iCk..................................................... Operator Certification Number; I -----�_k ...........---••-
Location of Farm:
ta►1� ....�4.�.....1t ...r � .... - ....... klla+117.. ....�+. ..."rvm...-.q&-sp....110 t....Nunn ....v-i 0.1..thsL.. ,s...........r
...--.e......U.P�4�. ...:..................................................-.-............---........................................---.-
Latitude I :' Longitude • 6 ri
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
600
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design -. Current
Poultry Capacity Population Cattle Capacity, Population
❑ Layer JE1 Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste :Management System
General
1. Are there any buffers that need maintenance/improvement`? ❑ Yes No
2. Is any discharge observed from any part of the operation? 1�1 Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes [4 No
b. If discharge is observed, did it reach Surfacc, Water" (If yes.. notify DWQ) ❑ Yes jj No
c. If dischar,*e is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) fA 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 §9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require [,S Yes ❑ No
maintenancelimprovement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 91 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 59 No
7/25/97 Continued on back

f Facility Number: 3 I — S
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure :3 Structure 4
Identifier:
Freeboard tft): ....... Z :a` .................... ......
...... .......................... ... .............
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?'
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes tO No
❑ Yes N No
Structure 5 Structure 6
.....................................................................................
❑ Yes N No
11 Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP. or runoff entering waters of the State, notify DWQ)
15. Crop type .......t __Ict .tom........................Wks ot................................................. .... C-e.G.u-M. c S
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/lnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
99 Yes ❑ No
CR Yes Cl No
❑ Yes N No
❑ Yes Ad No
.................................................
❑ Yes EZ No
El - No.violations or derkiencies. were noted during this'.visit.- You ;will receive no ftirtlier
eoerespotidence about this• visit'. -
❑ Yes 15� No
Yes ❑ No
❑ Yes No
Yes ❑ No
❑ Yes No
in Yes ❑ No
❑ Yes P�No
❑ Yes lP No
❑ Yes 1�a No
Continents (iefer to question #): ;Explain anynYES answers and/or any recommendations of -any other cammentS.�
Use;dravangs of facility to better explain situations (use additional pages as necessary) ru
�ry...
Z. SeTMe c4 wash �m,.. �,t use Wnssk �x s pV aaU4 �evjt U1ouk, noo VAt- COVId no {oe
h "WJ, No d i• Seta. e,
s- L,atN asca5 t� s it) should bG ��� a rtstt'deJ Or- a t)ratr�a�� s(tv� e �edt� d .
5�-�sy cocks in �naux'� �s�+ou�e� be� t^ec�_ Dr�;rta e, �esiae hovs�- shnf ja � �Ycs�,ode
1 /IZ Evos:o� o�. �tnw+r o c► ,�c,11s OT jayc,• sho��� lice w; ` _ 1
&Qas sI vkd b� rtseeJc- � ai, WCAIS a{ ja s�oujrl pn wdl, Cvi-iv, dAL- oc1
Ok Wtses s W 6p � 1U�� �G1 °Y` AKeeJed O) q,"k 54s�e,r i e skoufa ha-
ocj- io L y-a j �fi �reb�
� f
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature* Dater %Qfzl /A Y

Facility Number: ... 3.1 ...... Date of Inspection: 1 (qza/4-7
AdditIO-nal:Comments an or Drawings:.
Z-) \r.
Prot Css Of e CY k%Afconc�t��s&,haj1� I,-!; !Slv v
e �(Y�54lm Yecvek,
4/30/97

U
•
Site Requires Immediate Attention: lvU
} Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: y 1— , 1995
Time: / / 4/ 5
Farm Name/Owner:_;
Mailing Address: c aQCu t, s r -_ Po _N )xD-a 2 ttiAAA'k'� a AC, —
County:
Integrator. (+r r a
On Site Representative:
Phone:
Phone:
Physical Address/Location: C L F- ItOLe " "/
Type of Operation: Swine ✓ Poultry Cattle,
Design Capacity: � v 0 Number of Animals on Site:
/iU u i ur `/ S'` F N s�/f
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 ° 5-(0 ' SLf ' " Longitude: '? k"' ° o `{ ' qi " Elevation:' Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. n Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or
Is adequate land available for spray? �e or No Is the cover crop adequate? Ye7om No
Crop(s) being utilized: c� Cei7 / do C) j*rr
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? "I No
100 Feet from Wells? 6e�? 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 oZ% 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: j!v&k V r R qW rr',x4 r 4a i -
�
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.