090048_INSPECTIONS_20171231

UDivision of Water Quality ?T��—� 4---
Facility Number - 75 0 Division of Soil and Water Conservation S CE
0 Other Agency
Type of Visit: ��,,ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - . Arrival Time: ® Departure Time: ' ` D -Q County: ,1n..
Farm Name: Owner Email:
Owner Name: �-; 5�8w /Q'r-/ham �jTG Phone:
Mailing Address:
Physical Address:
Region: /___12Z%
Facility Contact: /;GLJ/LY� �1 5 Title:,��,.�, Phone:
v
Onsite Representative: Integrator:j/✓®
Certified Operator: f�yl 7�� �'��%� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
I/A001El Non -La er
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes ® No
[:]Yes 2-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: —
/�—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[]Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
jqNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑A,ppp�liccation Outside of Approved Area
12. Crop Type(s):✓`N2�dt4
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
®. No
❑ NA
❑ NE
❑ Yes
[MNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes jS� No ❑ NA ❑ NE
[]Yes allo ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes M 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 [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [a No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: 3-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
gLNo ❑ 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
[gNo ❑ 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
[a 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 " No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 52] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ZLNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exalain situations (use additional paces as necessarv).
SL''� r !`��/' �'J v`l�C L�✓�^� I,vr ,�2-i/; r-�vr�/ �/ i D %
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 5/p 330,D
Date: 3:�Z'z UZ.►2-
2/4/2011
Page 3 of 3

11
0 Division of Water Quality i C
Facility Number } O Division of Soil and Water Conservation
Other Agency
Type of Visit 9 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 Visil: (j' U Arrival Time: `�' �d Departure Time: , V U " Cottnly: 6 h�l�* Re' -,ion:
Farm Name: 1i is �a' ti 1' CYc-(/ /:d r rj L / Owner Entail:
Owner Name: L 15 j l ! c9.'rr I Phone:
Mailing Address:
Phvsical Address:
Facility Contact: ^&Z'W?as-I AJD✓✓ l l illc:
Onsite Representative: /�
Certified Operator: 1—/J�D�Ber
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator aLe`
Operator Certification Number: ! C�
luck -up Certification Number:
�«
Latitude: ❑o Lonaitudc: =o
v
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�O ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
ElPullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
ElDairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Cow
Number of Structures: a
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 SNo ❑ NA ❑ NE
❑ Yes
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
ElDairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Cow
Number of Structures: a
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 SNo ❑ NA ❑ NE
❑ Yes
Number of Structures: a
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 SNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
` I NE
❑ Yes
[ l No
❑ Yes
� No
❑ NA
UI NE
❑ Yes
ER No
❑ NA
❑ NE
12128104 Continued

n
Facility Number: g — Date of Inspection — F 77
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[Yes
❑ No [ _ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
PI -No ❑ NA ❑ NE
Structure I Stnucture 2 Structure 3 Structure 4
Structure ;
tilrUcture 6
Identifier:
Spillway?:
Designed Freeboard (in): 01,E — 4
Observed Freeboard (in): 13
5. Are there any immediate threats to the integrity of any of the structures observed?
< < j 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
C Yes
No t_S NA Eli 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
(y i No ❑ NA 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W 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
9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
FX No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
(ENO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)✓
13. Soil type(s)
6- / Du
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
C] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
14 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes '
(,;I No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�� �6rvan Wok
AL
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: —
12128104 Continued

L
Facility Number: —G Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QNo ❑ 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
9No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Callo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Eq No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
n No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Eallo
❑ 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
MN o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
Gomnitts a"W
12128104

Quivision of Water Quality Wit`
Facility Number l� "/ � 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (D<'o—m ppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: —gC� Departure Time: %3 l7 County:''
Farm Name: �.Syrrn� �/ A—'�42trY— Owner Email:
Owner Name: ea
l s —1—ric Phone:
Mailing Address:
Region: tiz:i1
Physical Address: % Facility Contact: /� li�1LtY AA J-I,(;3 Title: S� u !' Phone No:
Onsite Representative: Integrator: `IZzt24yvL
Certified Operator: ref rj �� Operator Certification Number: o "
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = c = l = Longitude: = ° a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
D� ❑ Non -Layer
❑ Wean to Finish
S-Wean to Feeder
Feeder to Finish
©010
® Farrow to Wean
,5—00
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cott
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 2-No ❑ NA ❑ \ 1
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes R No ❑ NA ❑ NE
❑ Yes %No ❑ NA ❑ NE
12128104 Continued

♦ 1
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes (LNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®.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 ANo ❑ 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 EJ-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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes ❑ No ❑ NA [__1NE
maintenance/improvement?
] l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
/ -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
6No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination"[—]
Yes
9R.No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:j
Page 2 of 3 121281W Conttnuea

r
. a
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E.No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
00,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 'No ❑ NA ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
N 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
Q 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
[RNo
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
j5qNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Pa" e 3 o/ 3 12128104

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
090048
Facility Status: Active Permit: AWS090048 Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County: Bladen Region: Fayetteville
Date of Visit:
03/31/2017 Entry Time: 11:00 am Exit Time: 12:00 pm Incident #
Farm Name:
Lisbon Sow Farm #1
Owner Email:
Owner:
Lisbon 1 Farms Inc
Phone: [phone]
Mailing Address:
PO Box 1139
Wallace NC 284661139
Physical Address:
368 Shepard Rd
Council NC 28434
Facility Status:
Compliant ❑
Not Compliant Integrator: Murphy -Brown LLC
Location of Farm:
Latitude: 34' 29' 56" Longitude: 78° 32' 29"
From Lisbon take SR
1713 South 1.5 miles, turn right onto SR 1765 (Sheppard Rd) and go 0.5 miles to farm entrance on right.
Question Areas:
Dischrge & Stream Impacts
Waste Col, Stor, & Treat Waste Application
Records and Documents
Other Issues
Certified Operator: James C Smith Operator Certification Number: 17907
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Michael Ammons Phone
On -site representative Michael Ammons Phone:
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Robert Marble
Phone:
Date:
page: 1

Permit: AWS090048 Owner - Facility : Lisbon 1 Farms Inc Facility Number: 090048
Inspection Date: 03/31/17 Inpsection Type: Compliance Inspection Reason for Visit. Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Farrow to Wean
3,500
Swine - Feeder to Finish
1,000
Swine - Wean to Feeder
400
Total Design Capacity: 4,900
Total SSLW: 1,662,500
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.50 36.00
page 2

Permit: AWS090048 Owner - Facility Lisbon 1 Farms Inc Facility Number 090048
Inspection Date: 03/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na Ne
1. Is any discharge observed from any part of the operation?
❑
❑ ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ M
❑
b. Did 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)
❑
❑ 0
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na Ne
4 Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (i.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑0
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
MEI
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page 3

Permit: AWS090048
Owner - Facility Lisbon 1 Farms Inc Facility Number: 090048
Inspection Date: 03/31/17
Inpsection Type Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na Ne
Crop Type 1
Coastal Bermuda Grass w/
Rye Overseed
Crop Type 2
Corn, Wheat, Soybeans
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Autryville loamy sand, 0 to
3% slopes
Soil Type 2
Nahunta very fine sandy
loam
Soil Type 3
Exum very fine sandy loam,
0 to 3% slope
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
M ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
NEI
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
M ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑
❑
If yes, check the appropriate box below
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page 4

Permit: AWS090048 Owner - Facility: Lisbon 1 Farms Inc Facility Number: 090048
Inspection Date: 03/31/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na Ne
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
E ❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑ ❑
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?
❑
E ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑ ❑
Other Issues
Yes
No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
E ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
E ❑
❑
page: 5

'-r- '1-
ivision of Water Quality
Facility dumber 0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: (DC-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
2eason for Visit: (Dtcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 13 ad' -I y 1 Arrival Time: $' (7 Departure Time: County: w, t
Farm Name: L s`�i,L, / Owner Email:
Owner Name: t:;.��,Dr-t iGQrr+'tS r7G, Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: %1'�rG�r-/p?>NLytS Title: Phone:
Onsite Representative: fg, c Integrator: Of lai 1'
Certified Operator: l��.5 Apfe_ Certification Number:
Back-up Operator:
Location of Farm:
Swine
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer G/p o 0 o I +___1
Wean to Finish
Wean to Feeder
Feeder to Finish
/0Vf)
l0va
Farrow to Wean
�'VZ
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Pouitry Canacity Pon.
Layers
Non -Layers
Pullets
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [" No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JS No
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: T -_qk Date of Inspection: —,o;LAr-'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / cl
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ®No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes allo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No
❑ N A ❑ 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 a No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s) `.�r/f�tcxa�e� I �9ti�,x �r�� Co /n IWt ,11S
13. Soil Type(s): t'—:Lx/1 / 12 Uj¢ �I�f i} h%Q`g 1 &d
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 ❑ N E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ 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
❑ 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 ❑ 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 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rZ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes [RNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes No
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes 2,No ❑ NA ❑ NE
❑ Yes C�J_No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes �No
❑ Yes N No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: 5-7 1-� Phone:/O` yJ 33 a
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

0 Division of Water Quality
Facility Number �� 0 Division of Soil and Water Conservation
F0 Other Agency
Type of Visit 6 Com fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: © Arrival Time: �0 Departure Time: ; VolCounty: �(� Region: L�
Farm Name: _­"VrU fOwner Email:
Owner Name: L �� �'- 1 ae �n Phone:
Mailing Address:
Physical Address:
Facility Contact: h �5 ✓S
Onsite Representative:
Certified Operator:G (�
Back-up Operator: L�
Location of Farm:
Swine
Title:
Phonee No: VO �/ _ V 9_3�
, Integrator: a y /J Iq p�
Operator Certification Number: o
Back-up Certification Number: % ! 9�r 7
Latitude: F7c = 4 = Longitude: = ° = , = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
Dg-Farrow to Wean
Q
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,_No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection _
_ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R.No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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.)
'R
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
JR 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
,NNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�] No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EN No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
6No
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
IN
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JZ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
jEl No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.®-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
53 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
PNo
❑ N A
❑ NE
the appropirate box. ❑ ATUp ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
J&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain
Inspections
❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
8 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Jallo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;jNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1,No
❑ NA
❑ N E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[K No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
allo
❑ 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
allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,&No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

ivision of Water Quality S _
[Facility Number 6 O Division of Soil and Water Conservation
O Other Agency
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:
1 /40: 00
i UCounty:
C
Farm Name: �— �S� ?!!Jn— _ tom E-z /n
Owner Email:
Owner Name:
S—
Yl L-
. Phone: _
Mailing Address:
Physical Address:
Facility Contact: �t 5 . �1y/ i Title:
OnsiteRepresentative: Certified Operator:
Operator:
Back-up Operator:
Location of Farm:
sly ine
Re -ion:
Phone No �—
Integrator: Y-e
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 =` �" Longitude: = 11 =I = <<
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
l CJfJ 00 D ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
r✓00
Farrow to Wean
D
O
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
El l'urke Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ DairyCalf
❑ DairyHeifer
El Dry Cow
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 71
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑lc, X\u ❑\\ ❑m
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
t4 No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
12128104 Continued

A.
Facility Number: — Date of Inspection G'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ek No ❑ NA ❑ \ 1
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ \ E
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): D
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes 9No ❑ \ A ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ N;a ❑ 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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 04 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) /Cp t L,
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
C4 No
❑ N:\
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination '?
❑ Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ' c �s,r� Phone:
Reviewer/Inspector Signature: Date: — t%

�. Facility Number: Date of Inspection ;� 1 x1S'/
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9LNo ❑ 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. ❑ W`Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R(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?
23. If selected, did the facility fail to install and maintain rainbreakers 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, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
go No
❑ NA
❑ NE
❑ Yes
NJ No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
Dd No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[E No
❑ NA
❑ NF.
12/28/04

t
('Division of Water Quality 5/Ic-'
Facility Number 0 Division of Soil and Water Conservation r/
0 Other Agency 49
IType of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -Arrival Time: Departure Time: ; OC7 County:
Farm Name: h� Sou. F,/,z / Owner Email:
Owner Name: �� oT�`'t- l Iota- ' • Phone: _
Mailing Address:
Physical Address:
Facility Contact: s77? i Title:
Onsite Representative:
Certified Operator: fB�
Back-up Operator:
Location of Farm:
Swine
Region:
Phone No: 9io _12
Integrator:,,-&
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: E71 ° F--] , F71 {I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
D O ❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
0
Feeder to Finish
�j
fK
Farrow to Wean
_VQ
❑
Farrow to Feeder
El
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
El Turkey Pouets
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairyCow
El Dairy Calf
❑ DairyHeifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
12128104 Continued

i
Facility Number: — Date of Inspection c7,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): c�p Q
Observed Freeboard (in): b(
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 DQ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,R No ❑ NA ❑ NE
❑ Yes J,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [K Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes [g No ❑ NA ❑ N E
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EN No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZLNo ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
[N 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):
7
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

t
Facility Number: — Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RI El NA [I 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 El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Callo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
5No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[A No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LK No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[R 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[R No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes]
No
❑ NA
❑ NE
Comments and/or Drawings:
11/10/4.4

M
Division of Water Quality
14,Ality Number L ! % D O Division of Soil and Water Conservation
0 Other Agency
Type of Visit (3,C'ompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: 3 0 1 Departure Time: '. l7 County:
Farm Name: G /� S iL7''V J�y cv �a�h2 Owner Email:
Owner Name: L- /S o fl'^— �a/ h s -�—�� Phone:
Mailing Address:
Physical Address:
Facility Contact: sJ�'!i Title:
Onsite Representative:��^�
Certified Operator: �O /17cC
Back-up Operator:
Location of Farm:
Swine
Region:
Phone //No:
Integrator: /l7IV44 �f
Operator Certification Number: ��Sg
Back-up Certification Number:
Latitude: = = i = « Longitude: = o = 4 = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
QO ❑Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
V O O
D 0
Farrow to Wean
DO
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
El NA
El NE
❑ Yes
� No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
,4 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection LAC
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EQ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[.No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): do
Observed Freeboard (in): 72i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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? EK Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ®,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes IM No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 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) (err. (- ZI-14 Fay h`.��dusoc TTrr-y
/(lGlc
T/Si�.c�'C�ra1a/�
13.
/f
Soil type(s) _�( A �� y� Q u A Z N D �r / Y L
13
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LKNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
10 C*-M'n a -f W IV k-1 7 P*,- 116� pl- b4l.-r- awrat- lk7-ta'&A.
Reviewer/Inspector Name Phone: 9/p 1�J33 3 33�
Reviewer/Inspector Signature: Date: J afl 0 lv
i-age L of J t l.Urlll""C"

Facility Number: —gj Date of Inspection
Required Records & Documents
• 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2jNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. L&Yes ❑ No ❑ NA ❑ NE
❑ Waste Application 12 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers 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, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑Yes
No
El NA
❑NE
❑Yes
No
El NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes P9 No ❑ NA ❑ NE
❑ Yes 50 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes IQ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

GID-ivision of Water Quality
Facility Number ,r O Division of Soil and Water Conservation
O Other Agency 1�
Type of Visit 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: Arrival Time: Departure Time: 4 County: XzQOIt� Region:Di
Farm Name: 15 b ow 5VW iI Gt /vy` � Owner Email:
Owner Name: ��.5 0.1 l ra✓rwt..s Phone:
Mailing Address: P D • Byx 7s9 Al e,
Physical Address: dii .-5 7-, %2J. / 7 (r.5—
Facility Contact: �a�C iL z" 'rt Y y Title: Phone No:
Onsite Representative:
Certified Operator: 5�,.,� iY C .,"L
Back-up Operator:
Location of Farm:
Swine
❑
Wean to Finish
Z
Wean to Feeder
0-Feeder
to Finish
lxpoo
l 9 Ho'Farrow
to Wean
S-Do❑
Farrow to Feeder
ElFarrow
to Finish
ElGilts
ElBoars
Other
❑ Other
Integrator:
Operator Certification Number: ,2 y j / O
Back-up Certification Number:
Latitude: = o = 1 = Longitude: = ° = , = «
Design Current Design Current
Capacity Population WetPoultry Capacity Population
❑La er
❑ Non -Layer
Dry Poultry
❑
La ers
ElNon-La
ers
ElPullets
❑Turke
s
ElTurke
Poults
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [IStructure ElApplication Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
ElDai
Cow
❑
Dai Calf❑
Dai Heifej
ElD
Cow
Non-DairyElBeef
Stocker
ElBeef
Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
RINo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Z No
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
12128104 Continued

Facility jlumber: — Date of Inspection �S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [K No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �Z No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9 6--
Observed Freeboard (in): 6 -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes (,Z 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 [ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ 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 XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2INo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) j5—: 'X —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
19 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
[RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
omments (re Y to question #): Explain any INS answers and/or aey t iilmendations or any mromments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
rit"vn
Reviewer/inspector Name ✓/ tvi= Phone:
Reviewer/Inspector Signature: _ Date: 1p —_,Z5_-7e),r"
12128104 Continued

FacilityrNumber: — Date of Inspection D i9 .S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
($No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ 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
[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
[RNo
❑ 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
[K 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
[K No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5 No
❑ NA
❑ NE
Additional Comments and/or Drawings: l
12128104

Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit i Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification Q Other
❑ Denied Access
Facility Number y Date of Visit: /O G o Time:
s
0 Not Operational 0 Below Threshold
la'Permitted 0 Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ..............
LFarm Name: ....�o..........Sm..'.... F4.................................................................Counri-• ........./
...............................................1.0.........
Owner Name: ,i ni 611.41 ..................................... Phone No: �l I 0 .28 `f /( 411l
MailingAddress:... P:.�...:...S7.ClX.................................. Q,S......... ........._5.................................
Facilih Cont^rt: ...... ir✓u.. . �f...........6.k..f;;�r................... _... Title: ......................................................... _..... Phone No:
Onsite Representative:...��.r�..... fi..�.c. ��....... ����!... Integrator`X. ..._M.....t.,P...%.�...............................................
Certified Operator: ......................: :c ............_/Gc/16�.�......................... Operator Certification Number:........`1(.J..C7
Location of Farm:
A,
[25wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ��
Design Current
Swine Capacity Ponulation
B-Wean to Feeder
y00
OTee,der to Finish
t pop
(Tarrow to Wean
_3.SOO
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I I❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons
Holdint! Ponds / Solid Traps
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation? ❑ Yes �10
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 D No
c. If discharge is observed, what is the estimated flow in gaUrnin'?
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 allo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [Tlo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... . .......................................................... .._................................ ........ _..
.......................
Freeboard (inches):
12112103 Continued

FacLity Number: cl — Date of Inspection /D �S
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or El Yes [�j'�vo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ETI�o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ON-o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [I Yes Q No
elevation markings?
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [2-Ko
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ElCopper and/or Zinc
12. Crop type Uei MVOI& . 1$10A Vew i Jn VO zd_< t W4er, 4_ la,.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [3-No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If ves, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
i
❑ Yes allo
❑ Yes t❑. -No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �o
❑ Yes [-No
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): field Copy ❑ Final Notes
A.
Reviewer/InspectorName 1110 . j( /3,-Gnf��y
Reviewer/Inspector Signature: Date: /p - 2(o o y
12112103 Continued

Fa:.ility Number: 9 — Date of Inspection
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
UINo
22.
Does the facility fail to have all com onents of the Certified Animal Waste Management Plan readily available?
(fie/ j3LCehe fists, d an, s, etc.)
❑Yes
Q #6
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O-No
❑ PP ❑-Preebeard ❑ ❑-Ser4-Sarnp1mgv
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
DNin
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
QNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
20
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Q-No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29-
'Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[}-No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O-No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O-No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
[moo
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
QWo
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
G-*o
❑ SteGkin,—gFerm ❑ CrQp 4ek� ❑,Rainfali- After-4="-Rai L_
❑ 1 ❑ A...naal-C-orr%F, otinn Fnrm
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit O Compliance Inspection Q Operation Review Q Lagoon Evaluation
IReason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 09 4R Date of Visit: 5-27-2004 Time:
0 N-ot O erational 0 Below Threshold
Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold : .........................
Farm Name: Uskton..Sotv..paximA.l................................................................................... County: Bladeu ............................................... ERO .............
Owner Name: ................................................... Lisbnn.l..k:artrns,.lnc..
MailingAddress: .................................................................
Facility Contact:
Title:
.......................... Phone No:(910.6.45:76.040 ........................................................
.......................... Rmsc.HWAC ......................................................... 2.M58.............
Phone No:
Onsite Representative: ........................................................................................................... Integrator: lY�ul�lhx..�lonA1�'..Rax�ms....
Certified Operator: Ricky ....................................... Bkjjkb.= ...................................... Operator Certification Number: 24.1.1.0.....
Location of Farm:
From Lisbon take SR 1713 South 1.5 miles, turn right onto SR 1765 (Sheppard Rd) and go 0.5 miles to farm entrance on right.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F 34 • 29 ' S0 Longitude 7A • 32 29 °
Design Current
Swine Canacitv Ponulation
® Wean to Feeder
400
® Feeder to Finish
1000
® Farrow to Wean
3500
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity 4,900
Total SSLW 1,662,500
Number of Lagoons 2
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... ...................................................................................................................................................................................
Freeboard (inches): ..................................
12/12/0.3 Continued

• Facility Number: 09-48 Date of Inspection 5-27-2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Ammlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
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
❑ No
Air Quality representative immediately.
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): ❑ Field Copy ❑ Final Notes
IQ staff visted farm as a result of an aerial filght that showed possible ponding and puddles arournd hydrants. Staff found no ponding
blems. At one hydrant wastewater appeared to be leaking from the hydrant and pooling around it. The pool had the potential to run
the field and into a nearby drainage ditch. Mr. Walt Burney and Mr. Ricky Blackburn were the company representatives and stated
y would build a berm around the pool to prevent it from leaving the area. Mr. Blackburn also closed a valve to stop the leak.
Reviewer/InspectorName Mark Brantley
Reviewer/Inspector Signature:
Larry Baxley
Date:

11
C4-Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation 10
0 Other Agency
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine p Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /i Departure Time: County: r
Farm Name: L _4p t, S'ocu Fay ` Owner Email:
Owner Name: L ; 4yr,p I GZCAS j� G Phone:
Mailing Address:
Physical Address:
Facility Contact: �;� il Title:
Onsite Representative:
Certified Operator: 49zz
Back-up Operator:
Location of Farm:
Swine
Integrator:
Phone:
Region:
/i71/ ND�I �y'f7uiti.
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ea No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
[:]Yes ❑ No
[—]Yes ® No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

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

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA gNE
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA 0 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
❑ No
❑ NA
1-1 NE
❑ Yes
❑ No
❑ NA
M NE
❑ Yes [:]No ❑ NA 2�NE
❑ Yes ❑ No ❑ NA [2,NE
❑ Yes [:]No ❑ NA � NE
❑ Yes ❑ No ❑ NA [�NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
2No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional paaes as necessarv).
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rapt re- %Dj
I ram- �l 404o'b 15;w
!1'i�` r` , GUI t:f F o - %D pi��ur�l,
T° i1 V'6 T6 I h �e. u 5z� •
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011