240025_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai

r
Division of Water Resources
Facilit? Number 0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: E) ConWliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: O/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l Arrival Time: r n Departure Time: rJ County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone: j
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry Capacity Pop.
La er
Non -La yer
Design Curt
lets
Poults
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ffNo [] NA '.Z!!— -
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes i�. ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number:{ - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): {�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[:]No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:]No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
,{] NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
❑ No
DNA
ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
J'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 I" Rainfall Inspections ❑ Sludge Survey.
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA .❑ NE
f
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Dumber: ^ t1 - Date of Inspection: t '}
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ No ❑ NA ❑yNE
25. Is the facility out of compliance with permit conditions related to sludge? If ves, check ❑ Yes ❑ No ❑ NA ❑.-NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [a N [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ENE
❑ Yes ❑ No [] NA © NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA
❑ NA FINE
❑ NA ❑!NE
Comments (refer to question 9): E*ain'any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better eplaiu situations (use additional pages as=taecessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
At
Phone: 1 () 77 G 7)11
Date: 113 c ! --
21412015

& Division of Water Resources i
Jr tacility Number F !-,(7 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Com ance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: l Departure Time: - a v County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
[Non -Layer
Design Current
Pullets
Other
Poults
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?
Longitude:
Design Current
Cattle Capacity Pop.
Daia Cow
Daia Calf
Dairy Heifer
Dry Cow
Non-DaiTy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 6 No ❑ NA ❑ NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes [—]No ❑ NA [] NE
0 Yes a'No
S ❑ NA ❑ NE
[—]Yes ❑ NA ❑ NE
Page I of 3 21417015 Continued

Fac ' ifity Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stru— ct- 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 [ra q'o❑ 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 ❑ o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes rNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ffNE
maintenance or improvement?
11. 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):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[] No
❑ NA
L6NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE[:_I
I & Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
�NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Required Records & Documents
19. Did the facility Fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[:]Yes [:]No [:]NA LJ 'vim
❑ Yes [:]No ❑ NA NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA [;]
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ���NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of -Inspection:
24. Did facility fail by
❑ Yes
❑ No
❑ NA
the to calibrate waste application equipment as required the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA 1�1
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
&NA ONE
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)
3 L Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 "L
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ZfKE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes [:]No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2<0 ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
� "%0 i►� �r
a 64 % �p -c- L /. 01)"A.
Reviewer/Inspector Name
Reviewer/Inspector Signature:'(
Page 3 of 3
one:
to7?G1.
Date: Q �"
21412015

40 Division of Water Quality
Facility Number O Division of Soiland Water Conservation
Q Other Agency
Type of Visit 6 c mpliance 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 j o a Arrival "Time: la'-15 I Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Swine
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = n =1 [ Longitude: = ° ❑ 1
Design Current Design Current
Capacity Population Wet Poultry . Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
C)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity, population
❑ Dairy Cow
❑ Dairy Calf
❑ DaiKy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 V�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No El NA El NE
❑ Yes El No El NA El NE
El Yes �NXo[:]
❑ NA El NE
❑ Yes NA ❑ NE
Page 1 of 3 12128104 Continued

4
' Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes q No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthrr at, 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 V 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 ElYes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes (L1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes C 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 Iand 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
1,7/ No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PINo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
6No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/inspector Name J P4 Phone: (.Q
Reviewer/inspector Signature: Date: f IQ h 0
Page 2 of 3 1 I2128104 ` Continued

Facility Number: Date of Inspection 7r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1 [I No El NA [TINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA L�NE
the appropriate box. ❑ W1Jp ❑ Checklists ❑ Design El Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA U(NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[)/ZN
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No
❑ NA�NE-
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
dNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ENE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
dNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Ef�E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�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 duality concern?
ElE 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
LTNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2f4o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12129104

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
IType of Visit (Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance — I
Reason for Visit Routine O Complaint 0 Follow up O Referral 0 Emergency O Other ❑Denied Access
Date of Visit: Zoo Arrival Time: I 1 s Departure Time: County: COW."%ju3 Region:
Farm Name: a. j Owner Email:
Owner Name: ���d I, Phone:
Mailing Address: / / "�'1 ` A;n I ),,L- _
Physical Address:
Facility Contact: Title:
Onsite Representative: 1iIh
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =, =„ Longitude: =o=, =„
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes U No ❑ NA ❑ NE
Page I of 3 12128104 Continued

4
Facility Number:
Date of inspection t t eg
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
❑ Yes EI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 CN ❑ 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 t7hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ 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 dNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA WNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA U 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
❑ o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[rNa El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[N El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
4d No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA
[ NE
Comment (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):
t) e's w--s pOES rJOT 14 AV OS.(— smi
31.) S+V WAS 10-XCD % co,Yal,�1' ALL, q(Af- , Dwq (Ait_W 0 AN.IWCR
gw,ow ueP lv1ALLc.D
PEE fia S a- LJ �r 0 S QC �-�'�r it r�l
Reviewer/Inspector Name �i o I j Phone; � � 6
Reviewer/Inspector Signature: Date: t ho
Page 2 of 3 12128104 Continued

Facility Number: '�%— Date of Inspection 1 t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA �NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ENE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
dNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather C�ode
22, Did the facility fail to install and maintain a rain gauge?
ElYes
[INo
ElNA
�
LY NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
dNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
❑ NA
rNE
26. Did the facility fail to have inactively certified operator in charge?
121/yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ZNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
EJ E
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
VNE
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
[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
❑ 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?
lLl Yes
❑:N
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
ElYes
LJ No
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

OFERRTI31-43 ];F:HhdCH - Z�U Fa;='a1r'-� 1�-r a 7'� JU1 20 '95 9 r
1,, V �
sit. rwq�as fmnod�ta �cn
Faduy Mulbw
SITE VISITA=N RECORD
Data; 7, / 6— .19M
Owner: br.-:L �f w - - Farm Name:
Couniy:
Agent plaiting Site: Phone:
Operator, Phone:
OnZta RepmsenWve: _ .. _ - _ phone::
PhyslCal Address; &e=cjX4 re,,-Cjov,r
gL,T�,,- L- AT F A 12 11 s ? —
Maiiing Address: ,-efr,_l,,dar, / �
r4b4Ir C; TY iVr—--2R46.3
Type of Operation: -,ZSwhe Potiitry Caft
Desl n Capa aty: Number cf Animals on Site:
Latitude: r �e� Longitude: °
Type ofir ckn.- Ground /Aerial
Circle Yes or No
Dom the Animal Waste mow have sufficient freeboard of i Foot + 25 year 24 f our atom evert
(approxhately 1 Rut t 7 inches) Yea or No
ActuW Freeboard:
Feet — inches
F. 14117 k
For facfliti= with more than one lagoon, please addmw ft other, lagoons' f %tc rd under the
comments sedton,
Was any seepage observed from 0* lagwn(s)? Yes or NO
Was there erosion of the darn? Yes or Na
Is adequate sand available for land application? Yes or NO
Is the oover Crop adequate? Yea or NO
A.ddt#ond Comrnents - r 7` 1rr
EQE r X,'rT U
f rr%�� d M .SL��itWq ■ �� �//r/7
Fax to [phone] 9, gnafura of Agent
*- 2. EncIb a �:`d-p

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIR NMANAGEMENT
MANAGEI�T
a S ANLMAL FEEDLOT OPE S SITE VISITATION RECORD
DATE: z / , 1995
Time:. -
Farm Name/Owner: J !C 017�r 7� 1!�Pci1 e7f
Mailing Address: .�_ l 6 T Y o ;
County: (-0 t1a in k,
Integrator:
On Site Representative:
Physical Address/Location:
k<- __2
Phone: !Z/0 11 _ '
Type of Operation: Swine Poultry Cattle / ll
Design Capacity: aci Number of Animals on Site: 112 S�e.,1 S [ HT4 '�PJ
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Cle ILongitude: 715 ° ' 2 6 " 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) or No Ac 1 Freeboard: Ft. Inches
•-; j,�k Was any seepage observed from the lagoon(s)? Yes or -o as any erosion o5served? Yes ore
Is adequate land available for spray? , or No Is the cover crop adequat:.? or No
Crop(s) being utilized: % L�
Dogs the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Mazy Blue Line? Yes o i o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain. 7h e
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Addzti al o ents: l� 1 �aw,� / 1>1".- Q rh-r
tie w e' rm-eW' G
. jet CA,Zz- zlo r M
A P L� i rs,"a � r� .7.rs �
J ct Il
Inspector Name mature
r S f�
cc: Facility Assessment Unit
Use Attachments if Needed

•
C7
Site Requires Immediate Attention: 1(6
Facility No. Z - 2
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: � A - , 1995
Farm Nz
Mailing
County:
Integrator:
On Site Representative:
Physical Address/Location:
'J
Phone:
Phone:
Type of Operation: Swiney Poultry Cattle
Design Capacity: Number of Animals on Site: %'� 'Se? co S
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ff///l " Longitude: 3 "' ' �" 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 incises) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the la I on(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray es r No Is the Cover crop
Crop(s) being utilized:
? [Yeses No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling' (G c/No
100 Feet from Wells?
r o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? YFo
o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes Ce
Is animal waste discharged into tens of the state by man-made ditch, flushing system, or other
similar man-made devices? &
or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage th cover crop) ? Yes orNo 1
W
/ I1 ' _N ,r 0
I
AA mwl m 1,1twe"W011%;
If
cc: Facility Assessment Unit Use Attachments if Needed.

SITE VISITATION RECORD
Mr. 7-- 1�--- ' 1995
Owner. %ala-7' Hei,-,,)- 77" _ Farm Marne:
County: � C'2 Z'W rra A u s
Agent Vtsiting Site:
Operator- Wr'A'e&j-
On ite Representalive:
Phone:
phone: 6U, -_43$ _44
Phone:
PhyslwfAddress: Fro�ft Tai,.br CIT4 WeraTQW% i.1,—i'QF&.TCA►R M; i
inv% ��r LP.P'-r SP- AP i1."I
Malling Address: zf 1,, 6oz / 4 .... ._ -„
a b r e-r F. )y G .2;P 4 Z3
Type of Operation: Swi Poultry Cagle
Design Capacity: Number of Animals on Site:
Longitude: f ��
Type of lrapfttlon: Ground IZAadal
Circle Yes or No
Does the Animal Waste L g= have merit fraeboartl of I Fool + 25 year 24 hour storm event
(approximately 3 Feat -t 7 inches) Yes or No
Actual Freeboard:
Feet -Inches
For faC110w wb more theft one lagoon, please address tlm other.lagoons' B oard under the
comments sedlon,
Was any seepage served from Me lagoon(s)? Yes or No
Was there erosion of the darn? Yes or No
Is adequate land avallable lbr land appication? Yes. or No
Is the corer crop adequate? Yes or No
Addidanal CommeTfS 4egn,=7";~g r tsar r7 -0eip g 7"Arp:t!g
,n e c Tc
Jy
Signature of Aunt Fax to [phone]

Is
Site Requires Immediate Attention: 7
Facility No. 'Z4-- Zf'
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �3 — 1 S , 1995
Time: 13y o
Farm Name/Owner:
Mailing Address:
County:
Integrator. Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes 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 No 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: S. +,--K s , 3�,L , ,A e,)
4Z 11,
1� e Ic- �d� sP,e,i1�-,
_�,v rz�s) � ; l l ►�--�� : ib� r e � v L..9 o F � - ru �..� L�� � i ; s
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.