820595_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

►v1S
57
Type of Visit: iDrCom nce Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint to Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit:Tim
J a Arfrival e: t�0 Departure Time: / S County: � Ofl%
Farm Name: L4.y A1ac7tp^- ✓✓t_ Owner Email:
Owner Name: I___Ra'r Phone:
Mailing Address:
Physical Address:
Facility Contact: CV «-� fS _ 50,rtu �7 Title: Phone:
Region: F (3
Onsite Representative: 1 f Integrator: 06-:5
Certified Operator: �-e4 fug - If /0 v1_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream lmgacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [D_140—n NA ❑ NE
a. Was the conveyance man-made'? ❑ Yes ❑ No &D -N<' ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [9-10C ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No EJ ';H ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes ❑-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ "Ro ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2015 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pauitry
Capacity
Pop.
Cattle Capaci Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
L jNon-Layer
I
Dairy Calf
Feeder to Finish
16 7 Z
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
Dry Proal
Ca aci
Po
Non -Dairy
Farrow to Finish
]Layers
Beef Stocker
Gilts
Non -Layers ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Other
Other
Discharges and Stream lmgacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [D_140—n NA ❑ NE
a. Was the conveyance man-made'? ❑ Yes ❑ No &D -N<' ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [9-10C ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No EJ ';H ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes ❑-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ "Ro ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2015 Continued

Facility Number:62—s 1 Date of Inspection: 6 --:;V AIL -,1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 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 E3 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 0 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
64011
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�
0 NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
Required Records & Documents
/
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(11,110 1,111
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
to ❑ NA
❑ NE
the appropriate box.
Waste Application
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3No
❑ 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): C 8 1 P '& 0
13. Soil Type(s): /6 W. -k-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 05o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No [:INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
/
19. Did the facility fail to have the Cenificate of Coverage & Permit readily available?
❑ Yes
0 -,Ko ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ca"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes V�40 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

r� 0
Facili umber: - Date of Inspection: ,b —> /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�ro
� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 Ej No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 02"No ❑ NA [] NE
Other .Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Siorage Pond ❑ Other:
❑ Yes [3'*No
❑ Yes U�No
❑ NA ❑ NE
C) NA 0 N
❑ Yes U3/No ❑ NA ❑ NE
❑ Yes D -11-o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? 0 Yes B o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question,#) E lam ;an YES answers and/or an addrttoaal recommendations organ other"commenft'd
Use drawings ofafacili i, o,better,e lain sttuations� nse additional a es.as necessa )
�l qtv- 308-- 6 85(
Reviewer/Inspector Name: r t In Phone
Reviewer/inspector Signature: c Date: 0(b S
Page 3 of 3 2/4/2015

(Type of Visit: Q Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: L?!S !!L_1 0 Arrival`�
Time: rp ( Departure Tim4u=
County:
Farm Name: L wt✓t_ � FjJV -E Owner Email:
Owner Name: ,� ulo, Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Cuc4 W 1.7c �., S, Title: Phone:
Onsite Representative: 1( _ _ Integrator: i 13�"�
Certified Operator: �- r>!!, -A 9— Certification Number: VIS
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 dischargc from any pan 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 [D'No ❑ NA [3 NE
❑ Yes ❑ No NA ❑ NE
❑ Yes [] No E51NA ❑ NE
❑ Yes [] No
❑ Yes
❑ Yes �No
ENA ❑ NE
0 NA ❑ NE
DNA ❑NE
Page 1 of 3 21412015 Continued
Design
Current
Dc ign
Current
Design Current
et Poultry
Cada itapacity
Pop
Finish
Layer
Dai Cow
Feeder„
17o
Non -La erDai
Calf
o Finish
367Z
may:
Dai Heifer
o Wean
+-Uesiga
Current
D Cow
Feeder
D �Poulf,
Ca i
P,o
Non -Dairy
Farrow to Finish
"7" Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars . Pullets
Beef Brood Cow
-
Turkeys
Other
_ Turkey Poults*^
x�
,
Other
10ther
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 dischargc from any pan 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 [D'No ❑ NA [3 NE
❑ Yes ❑ No NA ❑ NE
❑ Yes [] No E51NA ❑ NE
❑ Yes [] No
❑ Yes
❑ Yes �No
ENA ❑ NE
0 NA ❑ NE
DNA ❑NE
Page 1 of 3 21412015 Continued

Facilt Number. jDate of Inspection: 075
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E44kr--o NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ON E
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3"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 [3No ❑ 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 environm��N
hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
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
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
❑ Yes
Ea"No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [ "No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Required Records & Documents
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo
❑ NA
❑ NE
Excessive Ponding p Hydraulic Overload ❑ Frozen Ground
p Heavy Metals (Cu, Zn, etc.)
E] -No
[] NA
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
20. Dues the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
❑ NA
12. Crop Type(s): 1 C�wL -r�u Ut [z cV
the appropriate box.
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
[�fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ea"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O/No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E] -No
[] NA
❑ NE
20. Dues the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [31,jo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA ❑NE
Page 2 of 3 2/4/2015 Continued

Facilit Number: - 5 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3 N ❑ NA ❑ NE
21. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes [2'ro- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey C] 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 j7No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes. contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, ftreboard 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?
f�- gC.'--�
`7 7
Reviewer/Inspector Name: I.
Reviewer/Inspector Signature:
Page 3 of 3
&- 3 .. s ,-P-' -3 • Y
❑ Yes [5'1lo ❑ NA ❑ NE
❑ Yes r' No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes bNNo ❑ NA ❑ NE
❑ Yes
BNo
❑ Yes
dNo
❑ Yes
E"No
cliff - yo s'5(
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone `t M-3.7 J _1;
Date: ,� r+La'f 17
21412015

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ( *eutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
f Hz_
Date of Visit: � Arrival Time: r p Departure Timer County:` Region
Farm Name:L—O1A V "+' Owner Email: 94,
Owner Name: L--.,, or Iry Phone:
Mailing Address: _
Physical Address:
Facility Contact: coUlg fY.ct/'�'y l t IC Title: Phone:
Onsite Representative: It Integrator: A 6 " S
Certified Operator: 4 Alaeq Certification Number: /T W -S
11
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to f=inish
Design
Capacity Pop.
Will_OM1% Design
W,etPoulfry Capacity
La er
Current
Pop.
Design Current
Cat#!e Capacity Pop.
iry Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
Z
ity Heifer
Farrow to Wean
t° Design
Garrent
Dry Cow
Farrow to Feeder
D . P,oultryCa act
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers_
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ Other
Other
Discharges and Stream Impacts
1. Is any discharge observed horn 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)?
❑ Y es ❑ .leo— ❑ NA ❑ NE
❑ Yes ❑ No [3-1 ❑ NE
[:]Yes ❑ No 0-I I ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑No [3*NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �b ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes [r No [DNA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continuer)

00
[facility Number: Date of Inspection:
❑ Yes
�No
0 NA
❑ NE
Waste Collection & Treatment
❑ Yes
ffNo
❑ NA
❑ NE
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q-No-F
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E;�KA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
❑ WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements
❑Other:
Spillway?:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
Designed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
Observed Freeboard (in):
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ff No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
G24ro
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Page 2 of 3
2/4/2014 Continued
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Ukl�o
❑ NA
0 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?
❑ Yeso
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA
0 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
0 NE
maintenance or improvement?
Waste Application
'go
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;j0<D ❑ 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): ea ps G i>
13. Soil Type(s): IV&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes G "leo ❑ NA 0 NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes CC�i '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
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[7f No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2fNo❑
NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ 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
ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[2]"No
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

Facih Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes [ o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ROgo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? 0 Yes [2'Ro ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field - ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 2 --No ❑ NA ❑ NE
❑ Yes [/fNo ❑ NA ❑ NE
❑ Yes CTNo ❑ NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes rNo
❑ Yes 3.�o
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer;to queshou.#) Explain any YES answers and/or::any: additional recommendations or any other cornment§z„;
Use drawings o ' ;.. •M
Pfacility to better explam.situations (use additional:peges as necessary}.'.';° `Ca C4�CL
,�".e �� , /��- (5 - (L ,b - 3, 3 1P. ?, 6
Reviewer/Inspector Name: 1kLIA Phone:
1�33y
Reviewer/Inspector Signature: Date: tp
Page 3 of 3 21412011

Type of Visit: %0 -Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a a0 Departure Time: 4 County: y Region:-�
Farm Name: 44k/ y fiL on Fy-vi Owner Email:
Owner Name: L«a h1L Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:Y
Back-up Operator:
Phone:
Integrator, fQ (3 /
Certification Number: too
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
�" 'Design
Current
Des" gp Current
Swine Capacity P
oul Ce s achy
fop.
Cattle Capacity Pop.
Wean to Finish
La cr
❑ Yes
Dairy Cow
Wean to Feeder I
lNon-Layer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Dairy Calf
Feeder to Finish
[DNA—
❑ NE
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. I',oiiiltr Ca achy
I?o
Non -Dairy
Farrow to Finish
La ers
❑ Yes
Heef Stocker
Gilts
Layers
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Beef Feeder
Boars
Pullets
❑ NE
Beef Brood Cow
Turke s
Other
Turkey Poults
Other jj
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[[g4ft-_T] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[M'VA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[DNA—
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
[:]Yes
❑ No
2<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EloNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
t::fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

Facility Number: 6 Date of Inspection: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E] -Nu— ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [ ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
&I ` 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
"" ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes to ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q -Ko— ❑ 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 M1<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Ap lication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes n 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 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of WindDrift❑ 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 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:)Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [J'5 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 [�o ❑ NA ❑ NE
❑ Yes ❑'-N-b— ❑ NA ❑ NE
❑ Yes [2 ""' ❑ NA ❑ NE
❑ Yes [3<_
TJ 11° ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes E7r—No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ef No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 2/4/2011 Continued

FacHi Number: Date of Inspection: ✓'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E iqu ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Fto ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] I "1O ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
I a o
❑ 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
<o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
/
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
[j'NO
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
EWo'
❑ NA ❑ NE
[:1 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
E] Yes
s
&go
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E2 <o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[314o
❑ NA ❑ NE
Comments (refer to queshon;rt E%Jany MES aariswers and/or any addrhonal recommendations,or anym er conv
IIse f �
drawings.. -facility to b6ttebj&P ain situations,(use additianal:P a es as necess
la
CAS It 44a r- [
,T. -_r - / Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
i9 Phone:`
Date:
21412014

Type of Visit: EMompliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: ,la'ioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �1 ] �"' Region:
Farm Name: iI
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �(r-�) (�i�*�di/t�Title: T Phone:
Onsite Representative: �( Integrator: % �00
Certified Operator: '�-r` ��j �tyr B✓' Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Desig01 'Current
,.
Capacity.. ;Pop.
Design Current
Cattle Capacity Pap1.14Ma.
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
' `
Dairy Heifer
Farrow to Wean"
Design :Current
Dry Cow
Farrow to Feeder
D s �1?ouIt
Ca aci Ro .
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
k�
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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)?
[]Yes ❑ No 0] -NA ❑ NE
❑ Yes ❑ No lA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No Q NA Ej NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes E!f'No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ff"No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ ❑ NA ❑ NE
6 S a. If yes, is waste level into the structural freeboard? E] Yes ❑ No ffj-K ` [:]NE
10 V Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
❑ Yes
4�no
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
2<o
❑ NA
❑ NE
Observed Freeboard (in):_
❑ Yes
0 No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z],,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
1:1 -'Ko'
❑ NA
❑ NE
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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
U N
❑ 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
t❑Mb
❑ NA
❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Cg<o
❑ 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 l ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Be12. Crop Type(s):��
13. Soil Type(s): pok W K
14. Do the receiving crops differ from those desi`/gnated in the CAWMP?
❑ Yes
4�no
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1:1 -'Ko'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3No[3 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EK' ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ZO
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EfN ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E],N< ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
E]14K' ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
J. Ko ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E5X6 ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 Q'No ❑ NA ❑ NE
❑ Yes L j;Xo ❑ NA ❑ NE
[:)Yes io ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes nk<o
❑ Yes To
❑ Yes O leo
[DNA ❑ NE
❑NA E] NE
❑ NA ❑ NE
Reviewer/lnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
2/4/2011

Type of Visit: (QKompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (D/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / ` Departure Time: County
1
Farm Name: �, p�R.�(�V [p rP►R� Owner Email:
Owner Name: A R Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ^ Z IN MT—
Certified
T,Certified Operator:
Back-up Operator:
L< Title:
Region: Fid
Phone:
Integrator: R IeDwp
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes dNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No Eq"'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No Q(NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No 4NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
'"� ()
..
_
DaiHeifer
Farrow to Wean
Design
Current
DryCow
Farrow to Feeder
D , FEoultr,
Ca achy
P,o ,
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
:,_
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes dNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No Eq"'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No Q(NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No 4NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: ICA -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [}Uio ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No WNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -1 -L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3d
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [v"No 0 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 ❑114o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? [—]Yes Ba'*�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [-]Yes []VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ 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? X.�,
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes .0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acc table Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1+l U f"" " &o .
r
13_ Soil Type(s): lAORk-ol K, U A:RAfYI - -
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 2 --No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I & Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes [�J'No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ONE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes []kNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes [ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and t" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [SNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA C-] NE
Eg-NA ❑ NE
Page 2 of 3 214/2011 Continued

* 1v
Facility Number: a, -56 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes C2"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g-'�o ❑ 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 to ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [R<A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Eg-go ❑ 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 E3<o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Ejk<o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
EU4o ❑NA ❑NE
gall�o ❑NA ❑NE
[Q�No ❑ NA ❑ NE
[I No ❑NA 0 N
Comments (refer -to question #): ExplainanvYES.answers andloi any:iiifditio'nal recommenda'ttonstorany'other i omments.
Use drawings. of facility to' better explatn,sttyattons (use additionsl pales as necessary) F
�ttt� o n bpp-p— 5 P O"i-5 �► tZa rvQ -4 0 T n srT U'� w Q �1 P at3u r
Reviewer/Inspector Name: p� l Phone: C7 IU�r "�o0
Reviewer/Inspector Signature: Date: D3 d
Page 3 of 3 2/4/2011

°Q.Daviseon of Water Quality .
- � r
`FaCili Number � ,� � w - aSoil,and Water Conser,�vation
� R-01 Agency
Type of Visit: GrItompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (9 eutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: % 1. Arrival Time: Departure Time: ,pU County: Region:
Farm Name: Oaq or "—F`Lcrv," Owner Email:
Owner Name: or, . Phone:
Mailing Address:
Physical Address:
Facility Contact: 3_Lr� C–� Title: Phone:
Onsite Representative: Integrator:
Certified Operator: o(' Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
r
Design Current }
� Design
Current
Design Current
Swine
Capes Yty Popes .
Wet Poultry Cepactty
Pop.`
Cattle Capacity Pop.
Wcan to Finish
La er
Dairy Cow
Wcan to Feeder
Non -La er
Dairy Calf
Feeder to Finish
_
Dairy Heifer
Farrow to Wean
Design
Current*
Cow
Farrow to Feeder
D , 1',ault aaetty
P,oP.Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers-
Beef Feeder
Boars
Pullets
Beef Brood Cow
keys
Uther.
'
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Ea`*No ❑ NA ❑ NE
❑ Yes ❑ No [a< ❑ NE
❑ Yes [:]No EZ� ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C3<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes F::f ❑ NA ONE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i -e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
10 ❑ NA ❑ NE
❑ No E],<A ❑ NE
Structure 6
❑ Yes �To ❑ NA ❑ NE
❑ Yes ®< ❑ 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 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E]- o
❑ 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 �10
❑ NA
❑ NE
maintenance or improvement?
o
[] NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 94o
❑ NA
0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
( No
❑ Outside of Acceptable Crop Window i0 Fvidence oaf Wind Drift
❑ Application Outside of Approved Area
18. Is there a lack of properly operating waste application equipment?
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designate in the CAWMP?
❑ Yes
o
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J21"'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q 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
C; iNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L3<o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2190
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes O o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
Q -<A ❑ NE
Page 2 of 3 2.1412011 Continued

Facili Mumber: - Date of Inspection: Jo
/
24. Did the facility fail to calibrate waste application equipment as required by the perm t? ❑ Yes 2.191 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &2,<o ❑ 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 [ o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ®-Nf
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EKo ❑ 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 [Q< ❑ 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 �o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes tg lvo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [21�o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [a415' ❑ NA ❑ NE
Comments (refer to" question #i): Explain any YES answers and/or any additional recommendations or-any%other m
coments.` "
Use drawings of facility to better explain situations (use additional pages as necessary). r
W—rv, cry,—
CLC64.Lr+ A let cr�
Reviewer/Inspelctor Name: ,,/ E Cj,� Phone: 1,10 WM
Reviewer/Inspector S" afore: Date:
Page 3 of 3 21412011

21.z6120/V �
'2 H 5795
Type of Visit G? compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:2 �, s /O Arrival Time: Departure Time: 2; 3O County: S4tg- r -2W Region:
Farm Name: Q y`r �ury�" ` Owner Email:
Owner Name: L 4y r .9 __ Phone:
Mailing Address:
Physical Address:
Facility Contact: C sem+ � Title: `-t SPt-< < Phone No:
Onsite Representative: (l,1,s-#1's�t�}e- Integrator: /W~
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =O =g =" Longitude: E__10=11 =10
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
n Curren t
Cattle CDesigapacity Population
❑ Wean to Finish
❑ La er
❑ Yes
❑ Dairy Cow
Wean to Feeder 110
Non -Layer I
ai Calf
IN
LI Feeder to Finish
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
I
11 Nan -Dai
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
NE
❑Turkeys
❑ Yes
(3ther
❑ Other
❑ Turkey Poults
❑ Other
kum6er of Structures a
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Lr No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Feld ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�lA
❑ NE
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[34A
EINE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
El2 Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
K1
SIo
[:1 NA
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2 110
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Number:Facility —
Date of Inspection
Waste Collection & Treatment ,,_,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElL'
Yes . 1, o El NA NE
a. If yes, is waste level into the structural freeboard? El Yes EKo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -277
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 15No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes �I [❑ 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 2 N/o� El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3<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 L'T�io ❑ NA El NE
maintenance or improvement'?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M 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)et-4�..e4 ��7�-l��ro.�n/
13. Soil type(s) /41o/ (J.l Ls
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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
[-No []NA ❑ NE
L<o ❑ NA ❑ NE
2-5o ❑ NA ❑ NE
Vo ❑ NA ❑ NE
Io ❑ NA ❑ NE
Comments (refer to question #): Explain any YES
Use
and/or any recom 'endahopsyo any other comments. l
Use drawings of facility to better explain situations. (use -additional pages asinecessa. F
Reviewer/Inspector Name I i e �C c �t_S E- so Phone: %O • SF 33. 3310
Reviewer/Inspector Signature: Date: —Z.S7— Z b/O
12/28/04 Continued

Facility Number: 62 --S f- j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
❑ YesNo'
Does record keeping need improvement? If yes, check the appropriate box below.
❑ NA
❑ NE
El Yes
LlNo
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ENo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
No ❑ NA
❑ NE
❑ Yes
EJINo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,_e�o/
31' o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9<o ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®'o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R<o ❑ 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<o [:INA
❑ 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
EJINo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerlinspector fail to discuss review/inspection with an on-site representative?
ElYes
8.5 ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Edi IoEl NA
❑ NE
j
AddltiOASIr[`OlnrAe�t s alit Or Dr8W1 r w •s»
i
12128104

61W –0-6 guar
Type of Visit '�). Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit () Routine 0 Complaint Q Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: ffl i Arrival Time: E&ikl Departure Time: r� 1 County: ffal
Farm Name: . zirr'f h/ a1 I& /'"i J Owner Email:
nwnerNnme- L11/t✓v Rl��/'!� PhnnP-
Mailing Address:
Physical Address
Region:)
Facility Contact: LArIlfPOV/&- Title: {� Phone No: 0
Onsite Representative: t Integrator: _�[v,—,
Certified Operator: _ Operator Certification Number: ?qG
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 El ` El u Longitude: =0=4
0=4 = «
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ NE
E]Dairy Cow
❑ No
Wean to Feeder 13 &-7Q,❑
Non -Layer
E]Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Non- Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Gilts
❑Nan -1,a Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cow
❑ Turkeys
tither
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Dischames & Stream impacts
t. 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 037No ❑ NA ❑ NE
❑Yes 0 N E] NA E-1 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes FR -No
❑ Yes RNo
12/28/04
❑ NA ❑ NE
El NA [I NE
Continued

S
Facility Number: a — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IyNo
❑ 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 0
Identifier:
Splllwly?:
Designed Freeboard (in): Ct
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t9 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
;KNo
❑ 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?
IKYesI[No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5"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
C1 Yes
JK No
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
`B Yes
❑ No
❑ NA [:INE
❑ 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
IS Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1..1'Jfit a l 8e m wh_ lky ;S-6 o S
13. Soil type(s) La A,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IK -1 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination's ❑ Yes
r,;Z No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
© Yes
rg No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ 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):
4
•
Reviewer/Inspector Name SC -04' Phone: q33-3300 X303
Reviewer/Inspector Signature: Date:
12,284W Continued

4
Facility Number: a — Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWIVIP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JRNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No E'NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
_R 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
19 NA
❑ NE
Other Issues
�Hof\,
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
1�1 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? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IN No
❑ NA
❑ NE
.
Additional Cam®ents:add/or DrawingstAL
-7. Pif#,e C h6ndkotd 4ree 01 bact'r srrd e 47P faya h,
{��e work a1 layer cam on back side � 1966-7
Qn�s rQ� e��-�- e� �r eld- War Qlo�,e f%7 ate- ©c�6�> Ra, ca f U � b �
11 r � ,��,,,,[low pla, or ham tfi
4v
be
rnoar-��°d _T nf eve) CIge 9v 6ef`y oed �l
� -h,¢ Lir nom a b Ve79oa� 1O01e� `O' m q Fell-�i re(o dl.
1
Srve SA©wsIld"e569'V61'300 ,}eSI*
[CI a�� cad n* a bove, n
�l�4f'ccho� l sef 0f jot� `h+a�-er�jCrop i'lho' was- a,-?
�Hof\,
Page 3 of 3 12128104

Facility No. $a- V�F Farm Name
Permit COC
-
Po . Type_ Design Current
Design freeboard
Observed freeboard (in)
Sludge Survey D te
Liquid Trt. on
�a%l' l3 CY Date Th1/09
OIC! NPDES (Rainbreaker PLAT Annual Cert )
'ROWW Ma, QA1'51- 6 (-61�-N par),H FV/MS
OEM
Design dth
W -TOW M.11
Soil Test Test Date
pH Fields fa - 1-1
Lime Needed A fi�aJ�
Lime Applied4 Qq
Cu'0 11
Zn
Needs P
Crop Yield
Wettable Acres
WUP
Weekly Freeboard ✓
Rainfall >1"
1 in Inspections
120 min Inspections ✓
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Waste Analysi Date Ci�GimC+�
.r r.
Pull/Field Soil Gro RYE PAN Window Max Rate Max Ami
CB 067 G'- 110
t 3
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 6103 S 1 js4pate last WUP at farm App. Hardware
FRO or Farm Records
Lagoon # ryP,4 Grp-S�ta�Pa� Grn vr►
Top Dike CK)_ Stop Pump lh"5'
Start Pump %L
in

P )Nf -1vf 0)131tw -- -- -
Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: E� Arrival Time: Departure Time: /4 County: S Region: FRO
Farm Name: L frr,4 1Vaylor FOwner Email:
r
Owner Name: Latu A Phone:
1
Mailing Address: r� 01 &138
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number: AWA Ig q 1_5--
I I
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0 ❑ 1 ="
Longitude: =0=, = "
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Cur'..
rent
RNo
Design Current Design Current
Swine
Capacity Pop fation
Wct Po.ultr? `..Capacity
Population: Cattle Capacity Populatioa
❑ an to Finish
❑ Laver
A
F ❑ Da Cow
❑ Wean to Feeder
[INA
❑ Non -Laver
❑ Dairy Calf
Feeder to Finish
is 3$
❑ NA
❑ Dairy Heifer
❑Farrow to Wean
❑ Farrow to Feeder
Dry Poultry ❑pry Cow
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
`� ❑Beef Stocker
❑ Gilts
❑ NA
❑Non -La ers
❑ Beef Feeder
w ❑ Boars
® No
El Pullets
❑Beef Brood Co
A
Y
ElTurkeys
❑ Turkey
r • .: ;
.Other.
❑Other
❑ NE
Potilts
❑ Other
t77Number of Structures: -�
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field [] Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[INA
❑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
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JRNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
IW8104
Continued

Facility Number: 4g a —r Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(a 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): 19
Observed Freeboard (in): 3a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 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?
C@Yes
❑ No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C'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
JR No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
INNo ❑ NA
❑ NE
mai ntenan ce/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P9 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) Co hf4 L 6ffM u& (41 1 ` SG Q_r
�-
13. Soil type(s) WaB Is.', t NQA I 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
C9 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IR No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No ❑ NA
❑ NE
Reviewer/Inspector Name SC E jEX 1 Phone: L9() 433-33WX
Reviewer/Inspector Signature: Date: a2h910
Page 2 of 3 12128/04 Continued

• Facility Number: $ a- -Sq Date of Inspection 0�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g E] Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
18 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CR NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
EINE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
§a NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C'No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
IaI 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
IffNo
❑ 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
19[No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KINo
❑ NA
❑ NE
Additional Comments and/or Drawings
5, PIfoje-iaOrn I tele Pihe tfff- be& f V e OfI�POA-
V ie4e k,,e y,&* p, cry bae- S fAS 011 &1 yv4 ,
r
ay, Saone reds ar $3-34s, Nfeds Cal a009,
aY , v4d-S (,6, PoA + Pleaw, kfee with Diha- recodll
V
NUS 44 1a19-:
siotesaveJ Pprftrm4_ -71aalOsQ L ban oafley, S1 K4 collo, 47,*01 mP 'h,newS&Ad.
Page 3 of 3 12/28/04

Facility No. SCIS FarmName
Permit COC ✓ OIC
Pop,Type Design Current
Date
NPDES (Rain breaker
PLAT Annual Cert )
Freeboard 1 2
3 4 5 6 7
Desi n
BIMS
Observed in
Sludge Survey Date Perm Liquid(ft)
Sludge Depth ft
AdE j A
. -Calibration Date
MOA 12,
Design Width -------
Sail Test Date aar,
pH Fields
Lime Needed A ,Wll
Cu '-Zn —
Needs P kin
Crop Yield
Wettable Acres
WUP
Rain Gauge aTO
Weekly Freeboard
Rainfall >1"
1 in Inspections -�
120 min Inspections
Weather Codes ✓
Transfer Sheets N/.4
Krt0� ✓
Waste . _Analysis Datenmrrc���e�rs�
N Amt 000 -
0-T- 0.6 Inhu- - LO "/hr

Type of Visit `Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visite E0outine Q Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access j�
Date of Visit: LX I SIU j j Arrival Time: ® Departure Time: County: Region: }'"'V
Farm Name: �Q � �"' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address.,
Facility Contact:
Onsite Representai
Certified Operator
Back-up Operator:
Title: V Lar _ hone No:
Integrator: MM
�9ZK — Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [::] 4 [--] ' ="
Longitude. [_—] o =' = W
Design Current
❑ Yes
Design Current Design Current
Swine C►apacity Population
Wet Poultry
Capacity Papuan C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
I ❑ Dairy Calf
eeder to Finish 7.1
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non-DaiEy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
❑ Turkeys
rp-
PNo
1Other
11a0ther
❑ Turkey Poults
❑ Other
Number o€Structures:
❑ Yes
)�?No
❑ NA
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[*No
II
❑ NA
El NE
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ NoA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
ElNo
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
ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rp-
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)�?No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28104
Continued

Facility -:Number: — q
Date of inspection �J
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?
Struct e l Structure 2 Structure 3 Structure 4
Identifier:
❑ Yeso El NA [:]NE
El Yes No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes�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 )N -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 M.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 )KhNo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
7u'
Reviewer/Inspector Signatur, : Date:
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
kNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or I0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWindDrifi ❑ Application Outside of Area
12.
Crop type(s) ttL�-11'm `, 0, 0
13.
Soil type(s) W am !�)Dk-
14.
Do the receiving crops differ from those designated in the AWMP? ❑Yes
No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
KNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
MNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Rto
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
Mio
❑ NA ❑ NE
Comments (refer to question ft 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):
Reviewer/Inspector Name�1 ( Phone: Q
Reviewer/Inspector Signatur, : Date:
12/28104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did tate facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA El NE
20. Does the facility fail to have all components of the CAV#7" readily available? If yes, cheek ❑ Yes I�No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes oNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�§No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
bWA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�qNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'10
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
I%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
allo
❑ 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
;BNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
To
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Cotntni6s"ancilorDrawijs:"
1
Y► Ce 0. rn
�
�i sed Gcve ar�ea,)
14z44 op
s
Page 3 of 3 12/28104

Facility No. ��� Time In cU Time Out Dat 310-7
Farm Name f 0. �
or J m Integrator _ Pmt ,td_.
Owner I—M rk _ _ Site Rep
Operator .� ul No.
Back-up No.
COC Circle: General or NPDES
FREEBOARD: Deign
✓ L.�J t
Crop Yield
Rain Gauge b1_1__
-�1
0 Soil Test PLAT
Weekly Freeboard r Daily Rainfall
Spray/Freeboard Drop
Weather Codes , 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
."�
Observed
Caliirratior,/r__PM !
Waste Transfers
Rain Breaker ' '
Wettable Acres
1 -in lnspections
Date Nitrogen (N)
Z9 I ,Z-
'1 • `!r
Pull/Field Soil Crop Pan Window
v
cA r
.t1
/Vbr
Design Current Design Current
Wean - Feed Farrow - Feed
Wea- Farrow -Finish
ed.- Fi b Gilts !Boars
Farrow - can Others
FREEBOARD: Deign
✓ L.�J t
Crop Yield
Rain Gauge b1_1__
-�1
0 Soil Test PLAT
Weekly Freeboard r Daily Rainfall
Spray/Freeboard Drop
Weather Codes , 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
."�
Observed
Caliirratior,/r__PM !
Waste Transfers
Rain Breaker ' '
Wettable Acres
1 -in lnspections
Date Nitrogen (N)
Z9 I ,Z-
'1 • `!r
Pull/Field Soil Crop Pan Window
v
cA r
.t1
/Vbr

Type of Visit (3Komp1, ce inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1010b I Arrival
Tiime- pp Departure Time: County: Region: '!+ZO
Farm Name: 1r� Vu �U�' r Z.ia lm-�s Owner Email:
Owner Name: r 1 atAk 6r Phone:
Mailing Address:l
Physical Address:
Facility Contact:
Onsite Representative: NO
Certified Operator: V Y
Back-up Operator: C krt 5�
Y
Title:
%t' Phone No:
Integrator:H1�.iYl
Operator Certification Number- i 1
✓ Back-up Certification Number: Lq W q 33
Location of Farris: Latitude: = e = I ❑ u Longitude: a (I = I =
CJA.)Vt_1"_U ��'?0`5 3 rn• t c �ur+� `
Desgn " Current sMKI_Desrgrt Current' : Design Current
Swinr� 'Capacity PopW�ation Vet Poultry k��Capac►tyPopulahon_ „ Cattle" `Capacity Population
❑Wean to Finish
❑ Layer
❑ NA
❑ NE
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑DairyCalf
f5dkeeder to Finish 1 3(p7.�_i
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Citts
❑ Boars
�
Dty; r ff i
""_ ._
❑ Layers 1❑
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its I
❑ Daily Heifer
❑ D Cow
❑ Non -Dairy
Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
Niimbeli7f�Stiuttures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
No
WNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
*A
❑ 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
k 1A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yeso
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: —5q'S- I
Date of Inspection 0 0
Waste Collection & Treatment
❑ NA
4. 1s 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:
Spillway?:
fl
Designed Freeboard (in): aj
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No
❑ Yes No
[:1 NA [-I NE
El NA El 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 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes NNo ❑ 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 AgRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes[, No El NA ❑ NE
maintenance/improvement? J
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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) ZRXrn a�lic,. Vn
13. Soil type(s) -rj p`I/VV, , Iv (J)`( o i k-
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
Wo
Wo
Ll NA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
A No
�
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question ft 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):
A
P
Reviewer/inspector Name F k:�6 t f_ Phone: 910 - 33 -13dO
Reviewer/Inspector Signature: Date: _-Yul I o 2MC
Page 2 of 3 12/28/04- Continued

r
facility Number: Z —S;1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi Mas
Design ❑ p El
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes kNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes M No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ANo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ANo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes P.No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes M No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes J ,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ,NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
JgNo
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes 14 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes U No
❑ NA
❑ NE
Additional Comments and/or Drawings:'
Gwo j L t'c Clca &Y
7
Page 3 of 3 12/28/04

Facility Number Date D Time INOut
Owner N
Farm Name f Uff
OIC
No. IR�II�
C.O.C.[ General
U
D
1 0
Design
Current
Design C%urent
Wean to Finish Wean to Feeder
�to
_3 G-77- 'Farrow to Wean .
T - ~Farrow to Finish
Gilti Boars
Other
.Soil types
&)ar
�]U /
Crop Types �! Pan 'f Window 3 l - f6 b
a -�
Soil Test ✓ Plat
Designed Freeboard j Observed Freeboard
Rain gauge U --"
Rain breaker Daily Rainfall `--�Waste Transfers --
Calibration aqo
Calibration of spray equipment '� G.P.M.
Sludge Survey V Crop Yield - - 120 Minute inspections ----�
I in. Rain inspections L, -,/Weather code Weekly Freeboard
Pumping time
Waste Analysis % & Mond;
Comments
W4,j",te

Type of Visit 49 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 9.'7o Departure Time: County: �^ b� Region: r'080
F...,
Farm Mame: Owner Email:
Owner Name: pari NoY 0_s- Phone: _9me-41
Mailing Address: 9D/ _ C!, ceeXA R C�'., fes, �, NG �8 3 S?
Physical Address: 2 IQ eky-,_Li
Facility Contact: Title: Phone No:
Onsite Representative: /V, Integrator:
Certified Operator: /Y�. Inf Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
❑ . 0 Longitude: ❑ o =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder ID Non -La yei
2Teeder to Finish 1.06-7.2 3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _ - - -- Ji
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 oritzinated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: W,
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [a<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
215o
❑ NA
Cl NE
❑ Yes
2 No
❑ NA
❑ NE
12/28/04 Continued

8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
/ONo
❑ NA EINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Facility Number: bt - Date of Inspection 3 -
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Waste Collection & Treatment
❑ NA ❑ NE
maintenance or improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2rNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[TNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑0%
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Spillway?: ►?o
❑ 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
Designed Freeboard (in): �2 v_
.1400 .2 -1&
Observed Freeboard (in):- .2$-
2$5.
C
12. Crop type(s) ✓/�f6� 6,_p;a
5.Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
RrNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ErNo
❑ NA
❑ NE
through a waste management or closure plan?
❑ NA DONE
17. Does the facility lack adequate acreage for land application?
❑ Yes
If any of questions 4.5 were answered yes, aad the situation poses an immediate public health or
environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ONo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
/ONo
❑ NA EINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
ONo
[:INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑0%
❑ 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
.1400 .2 -1&
C
12. Crop type(s) ✓/�f6� 6,_p;a
I3. Soil type(s) L✓ae��' /�/�,� { _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RrNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
❑ No
❑ NA DONE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA aNE
18. Is there a lack of properly operating waste application equipment?
El Yes
,❑�No
IQ No
❑ NA ❑ NE
Comm ( r to questidnr#) Ezplattt any YE&asiswers�andl r a_oy re_coaimendatians or soy other comments.
Ilsedraw�ngs�nf facility to better erplaur sitnaaans.:(�se add,bonal pages;as netessar3):
` Rs / i Cv:eL.rar b�.t.9nfd
Tie 0101(s firrl� we"e as A., Ororss,r.� Crete �a,141/ '44
�a ryr n� wwJ
Reviewer/Inspector Name Phone: j f o- ` V4 !S� e �o
Reviewer/Inspector Signature: Date: 3 -
1212&104 Continued

Facility Number: Date of Inspection OS'
Rectuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2' to ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1;3—No ❑ NA ❑ NE
the appropriate box. ❑ >r�l❑ Ch fists gn ❑ 1W,aK ❑ er
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
3-!/-0-7.2, /!-/o--,/.S
❑ W4rstt'Appliea#��i��e❑ ' ❑ Weekly Freeboard ❑ ❑ ❑
�n ❑ ���]� �„ ,❑ GPoFjr:ic ❑ s ❑ M s ❑ wea�c[��,
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment`?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'
30_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? {ie/ discharge, freehoard 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
gNo
❑ NA
❑ NE
❑ Yes
0"No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
[2'No
❑ NA
❑ NE
❑ Yes
DIN
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
2 -NE.
❑ Yes RrNo ❑ NA ❑ NE
❑ Yes [2rNo ❑ NA ❑ NE
❑ Yes []"No ❑ NA ❑ NE
❑ Yes ❑"No ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Additional Comments'aud/or Drawings: '
•2'7 �%�.f iS 1r.'.,9 ��arnr� •slaw,
of P.'.,r ale 4/,e__ %,,oin, P/r4rt te.�y�aef
SC'""lpa�n to��><y
T/!e 7�rtt S gR!',ol 7 e9 �ot G�7�,
12/28/04

Type of Visit PrCompliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit 04dine O Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number nate of Visit: /S a Time: ; 00
Not erational 0 Below Threshold
U110 rmitted �rtified © Conditionally Certmed Q Registered
Farm Name: IZ------....illi.! 1 .............. ..... --._.........
Owner Name: ... `{......nn..�v
....... ..............
.„.._. _._...._.........._ ............
Mailing Address:..___... `. 0 /.......... [ lM- 4d . _.__................_......
Date Last Operated or Above Threshold: ..
County: _".°..d1+i.._......... _....:..
Phone No: __�%D �►... ���
Facility Contact: -_ /4,171e. Phone No:
Onsite Representative:....._._ /r __. _ Integrator: �•ir.•. 5
Certified Q razor: �' • "¢ rator Certification Nutmber: t
Location of Farm:
B'S'Wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �” Longitude �• �° ��
Discbarees & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes U<O
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gaVrnin?
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 ltd410
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes I40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure l Structure 2
Identifier: ......... -..)...................-._..._._
Freeboard (inches):
12112103
Structure 3 Structure 4 Structure 5 Structure b
Continued

acility Number_ g� —
Date of Inspection
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 andfor 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?
S. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes 2<0
❑ Yes [B"N'o
❑ Yes Mlio
❑ Yes [9<_
❑ Yes 21 or
10. Are there any buffers that need maintenance/improvement? ❑ Yes Levo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes M40
❑ Excessive Ponding ❑(PAN ❑- Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type '.7C _V- a dt� 5► 4 C� ie� %A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MIKo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [9 -Ko
Cottz�ts (refer gasst>!o �) Expiam any YES aststiwers aadlor airy recdi�enda#saas or; say'ot3ter cottiiaten�. � �` �-=� a
:Use drawings arf �t9 Gn better errpla�► st�atiots`s. (use addshanal pages as taeces�r3'} E �x teld COPY ❑Final Notes �- �`� r
b) Does the facility need a wettable acre determination?
❑ Yes
�o
c) This facility is pended for a wettable acre determination?
❑ Yes
[1i0
15.
Does the receiving crop need improvement?
❑ Yes
['To
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[RTo
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
Q'l�io
liquid level of lagoon or storage pond with no agitation?
l$.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
230
19.
Is there any evidence of wind drift during land application? (i.e- residue on neighboring vegetation, asphalt,
❑ Yes
❑No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
Q'Ko
Air Quality representative immediately.
Cottz�ts (refer gasst>!o �) Expiam any YES aststiwers aadlor airy recdi�enda#saas or; say'ot3ter cottiiaten�. � �` �-=� a
:Use drawings arf �t9 Gn better errpla�► st�atiots`s. (use addshanal pages as taeces�r3'} E �x teld COPY ❑Final Notes �- �`� r
Reviewer/Inspector Name
Reviewer/In_spector Signature: Date: /S
12112103 Continued

acility Number: ,Z — SIS I Date of Inspection e
Required Records & Documents
21. bail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After F Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yeso
❑ Yes G34o
❑ Yes �o
❑ Yes 0fiTo
❑ Yes [94o'
❑ Yes �io
❑ Yes EXo
❑ Yes [Oo
❑ Yes L_ O
es
❑ No
❑ Yes
OW
❑ Yes
1O0
❑ Yes
❑ Yes
i'90
&zo�
❑ Yes
9 -Ko'
B -No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtttonal Comments and/vr'Drawmgs
- Afl iya A P�"� 2i�C iYl Or�Q
1k Tao p
Mot
7
12112103

Type of Visit 0 Compliance Inspection Q operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Mae of Visit= _` --0� Time: • (Jr��
Facility Number � S9S
T%ot O erational Q Below Threshold
-Permitted M Certified 0 Conditionall-v Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: La+�Tv AAyloy- )CArkn _ Count,•: __ �G►r��+loh
Owner Name: a (-ry 111A"Aor- Phone No: 910 6611- 9W P
Mailing Address: C4, �AU, -V-3 X9
Facility Contact:
Title:
Onsite Representative -LA Ala glyr ``
Cerrif ed Operator: L eii%_ AIA A?i'
Location of Farm:
Q Phone No:
Integrator: &F_M /YM SA11014
Operator Certification Number: 18Y/I S
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �_ �0 ` Longitude ' �
Design Current Design Current _ Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder I I ❑ Laver I I❑ Dai
® Feeder to Finish JE3 Non -Laver I I 1LJ Non -Dain
❑ Farrow to Wean
❑ Farrow tc Feeder Other
❑ Farrow ro Finish Tota! Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area 10 Spray' Field Area
Holding Ponds / Solid Traps I J 10 No Liquid Waste Management System
Discharges .& Stream impacts
1. Is any discharge obsened from any part of the operation?
Discharrre originated at: ❑ Lagoon D Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If dischar ae is observed, did it reach IXaier of the State? (If yes. notify DWQ)
c. if discharge is obser►ed. what is the estimated flow in eal/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 CelltEton & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Freeboard (inches): a +
05/03/01
❑ Yes [MNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
(K No
❑ Yes
®. No
❑ Yes KNo
Structure 6
Continued

V.
Facility Number: —f�5
Date of Inspection f '
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed andlor managed through a waste management or
closure pian?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anniication
❑ Yes ZNo
❑ Yes ® No
❑ Yes K No
❑ Yes ® No
❑ Yes 29 No
10- Are there any buffers that need maintenanceiimprovement? [j Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑Yes KNo
12. Crop type Mt/ r4sr �� Clti'e4l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAIA%IP)? El Yes ®No
14. a) Does the facility lack adequate acreage for land application? D Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? Q Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16.
is there a lack of adequate waste application equipment?
Yes
No
Reouired Records d Documents
Reviewer/Inspector Signature: Date: 1.2 7` Q
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Pian readily available?
(ie/ vi'UP, checklists, design. maps. etc.)]
Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, frecbaard, waste analysis & soil sample reports)
[] Yes
No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
[] Yes
® No
21.
Did the facility- fail to have a active]-,, terrified operator in charge?
❑ Yes
No
22. Fail to notif+- regional DIVQ of emergency situations as required by General Permit?
(ie, discharge, freeboard problems. over application) ❑ Yes P No
23. Did Reviewer,Inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Fere any additional problems noted which cause noncompliance of the Certified AWNIP? 0 Yes JK No
M No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
. .lies .�-
Comments'(refer to quesboii #):'-Ezplata auq YES ansvPes S and/or: any rrtotteateadattonS oT sity-uther,COmmeats.
s - �.� ......:. .:__.
Use drawings of facility to better explant sit>Zatiatis: (rise addoaol pages as nttesssry) Field Cavy ❑ Fina! Notes:
flu!'=1"—.-:.ice «f�i'�{mow.-J:.� ...1 ♦T� xdry,C'^-a.��.:...:tl-x+.'.:4:Yf�.l.YY-i�iKN.' Lrw ��aClw
t- M
Reviewer/lnspettor Name _ a j .,: , '`. x� ,~ " - ;,;a�-v;�..� .�.
Reviewer/Inspector Signature: Date: 1.2 7` Q
05103101 01 Continued