820055_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

ivislon of Water Resources
Facility Number ! g^ ,�l - S S O Division of Soil and Water Eonscrvation
r 0 Other Agency
Type of Visit: �ommpliance Inspection Operation Review Structure Evaluation 0 Technical Assistance
tip Reason for Visit: #routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time. I 2.14oc) J71 Departure Time: E U County: f
4 i U ✓ )
Farm Name: �a w `0►i Cy[.W cl� `'t't Owner Email:
Owner Name: da ii de, �Z �av�py G�Phone:
Mailing Address:
Physical Address:
Facility Contact: C L,+R :L I S gav-wt` WV Title: Phone:
Onsite Representative:
'Lc
Certified Operator: Nei r-v e_w TT
Back-up Operator:
Location of Farm:
Latitude:
Region: F'� 24a
Integrator: `
Certification Number: "-,-q q JC
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop,
0
Wet Poultry
Layer
Non -La er
Design
Capaclty
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Feeder to Finish
Dt, P.ouItr
Layers
Design
Ca aci
Current
P,o
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ED,*a ❑ NA ❑ NE
❑Yes ❑No [ A ❑NE
❑ Yes ❑ No Eq-NA ❑ NE
❑ Yes ❑ No
❑ Yes �o
❑ Yes [/] No
[ENA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Condnued

Facility Number: �- 5 Date of Inspection: zr4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[S�A F_j NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No �
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EPK— ❑ 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
DNo— ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]-I<o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q ❑ 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
MN—o ❑ 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�lo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window,, ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑moo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LJ 110 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ED-Ko ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
[b No
❑ NA
❑ NE
[:]Yes
[-Ko
❑ NA
❑ NE
❑ Yes [3-lqo ❑ NA ❑ NE
[—]Yes ❑'NO ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EEKO
❑ 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 [alo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E? o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi Njumber: - Date of Inspection- Z70 �
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ®,Ko ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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:
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?
G-,I( Clio, 3 D �;- L. F5 r
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
G(ew—tp-f-f Cc�
❑ Yes ❑moo ❑ NA ❑ NE
❑ Yes NA [ NE
❑ Yes [2>tr� ❑ NA ❑ NE
❑ Yes [3,Ncr ❑ NA ❑ NE
❑Yes ❑ ❑NA ❑NE
❑ Yes NA ❑ NE
❑ Yes
4 ""
❑ NA
❑ NE
❑ Yes
®
❑ NA
[] NE
❑ Yes
F;-Iq-o—
❑ NA
❑ NE
m (? Phone: QIC�'3 3331
re: Date: lJ u t"c- f f
21412015

IY
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'po Departure Time: O cl 1 County: Region: '�
Farm Name: /'� %f�,1�y f—�rrn-� Owner Email:
IIII�_I..
Owner Name: G yfj ors �� ff �, �� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: ��;/rS_ �) Title: G, Phone:
Onsite Representative: Integrator: �� r� ✓�—'�
Certified Operator: czc- e �i-•-L.� Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
..I. .ill 1 1. r i I" i i Y" I' I. n•' .'ii.E - I51 II•. - i I,. i I 1 SI i ; i-d a '.II;
r I Y I t .I I ,I Ill
:. ,.:.,. II k,I� :J:. ." :n'. ':,"' 4� �''.�. ,,i,.' i1 �:•::: ,.,-.'I :-lY Pik 'J� 't � "YII`I 1 { I.<
� -�� I IS.i. " I f IF: 4 , 't:.. }
I is I It ' r l i f 43 Yiia 1,1=> 1�IY..}Iliiln.l , YYll. I �t} , 11' �3iIlISf i1 „ tl ^i
lllllllilll„,ttlllyli l hl};111J,I ) ! , It a li; Y �I t I l I.11 l#I#Ill .i li „ I!1 #l".iIit ;}� rill ,q•'3i�1ItrEl
f, II,I , Y �i�t Design Currents II jYYY ,Il, N;.I �! I,�•{Y;I Designs ICurrent,l:..�l l I . ,,I,ll}il�.l:,:.11�l,?ilr'I71 :,iY1i#11Y Designl:Y}Corr ntN,.,,
!{1lar �.. � � � SA J6„ - : ,, „ Ij I+ : i:;'41!•I .:ii r.nlll r. l rl! .•p, 1 .,.�i� i ill si_ it is 1V � f,: a `: V ,I *:F. LEII-' l•'.i.' Y III 11111 Y„u ...i l IY IIIl!I{IIF.f , III I .:, .. Y 411..,. I,. .Yi .,. , ,.I, +f. , k3 {�:: ii fit it 11i11 , ;.,F..... r It,
!`1`;4illl#I!Swine'i,l r,kll.Ca aci�:o'liai #tI�:N(+i.I6Wet PoWt I ri!.Cit` aci .I;l Po .'.Il 1 sit.?r @attic rltl�� 4It'f° Ca aci , ll#"Po': ai
Y...I i .I .. p... h" F..,:,. P i,k.:.....:, !r. , . .:-k.T �11I1 p ty..1. i,..P ::.1 lit 1}j1`�,,,..., l ts,.. 1.1'¢�3 3 i} ... P, ,. ,.t3'+4,..pllu.s,.r fII,
1 !t' - III4, ,I 114 _., IIp�1'ryj{' 4 +]i-! }.'. � - ,,. r � I I .g 6 IS11FI pI I , }', � li'i, I �.i.�.Ut�!!t`II1' �, IVf1„ Jc ,t tlSa. ,l.rvLi �ilUli:,ll l}i"�,,k.i,�1
- l.,,x9 ft4llt, IYIblId• i ! .,I ..I rvl,..IfIII1:1..r,Y.ILaU51.ilSly .1fnl .liYiiF�r:lnll�llr 1.,4.,.ra I I , 1 31: I 11, a.:.�It...�IIl3S r i,rrl 1 I II II lii. 1 .lu..�ri
Wean to Finish :�. Layer '`` 8 Dai Cow
Ii14 Wean to Feeder da ;�i' Non La er l N Dair Calf
1144 Feeder to Finish!,.`!I4rl"'ullfl�'lll�lllll4l.IGllII111t1 It�li�ll,j;ll[Illll t'II'��"(Ill,) I' "I Dai heifer �l
ifl s € �l 1€� �, I}(f
Y t� sfi #II I I 1 f Y I �si t,l! I { il� l � f
Farrow to Weanll)I,gitlj�il�,�)1jIIIlDesigrt�PCurrentilltl p Cow
i1Uiu,. ,as, : 1 ly �i
tr'ir Farrow to Feeder l'11I'.! IIIDPoult ItihIII�Ca acit !#!llllli'o �tilll�l ;1 Non-Dai aI'1
li Farrow to Finish �11�1 La ers Beef Stocker
{`ll Gilts li+lI Non -La ers i4`'}� Beef Feeder y'
tI} Boars i;�� Pullets( Beef Brood Cow �`:�•
! I t'il;Iri. I " §;II 4 <! }r+ •t" i j 111 °1f.!'+1 rr'4,UInt...r ^!: 4 QY i' Illl+iilr'" �1�1 INigIIH Its H) Y .,u,,fu, YI} {" , Y:r"I!I ^!d # llt r 1 u,ltlt 1'l rl#4Y, ny l
IYkklY.1 1, I:+ 4Y''Il3 trl :rl+:•I. Turke s Illl t#,'fk '� 1 Y} KlfG9 LIiR t t �l t:ll: r,<.
i }?+i1111i 1 ..N111t1,1�!Illll rl 3.IEI� t1 �- tl� . I II#i�11 .
�l
.Il,i . 'II.. 3? t I .i.. , .3,:rir A J--t III I �:- i p I{ , I��1 'i`I i y1 tll{ `I!n4 I}i •!�I.I Ilhl IlYfii„ Otherll�, .1., �+1 .. !f + tl' tt� + ,) . p Turke Poults
sift r+lt 1l li° 1 s' 1r l!ttt litE I} i ll i Ir Iri,l S�lslfx ltl' s II l!s
Other
�Y:i�ln nuuu,ununu '.- - n,nuun L- I I'I I:�rrla,walaunnwunua ;asr,alnnlnnm ,uunu<�I'�Iln I I , a,:. - ,lern'°s..iv!u„in`n.nn,n .o:,.:.:.a,u n,mnn .ran -,n a, iii [il I Iltl,le.. Yt:411 �I l�... %,e.: , nLP'i I "I ......
Discharges and Stream Impacts
T 1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidenc'etaf a past discharge from any part of the operation?
3. Were there any obser,vable adverse impacts or potential adverse impacts to the waters
of the State other than'from a discharge?
❑ Yes g No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[—]Yes E&No
❑ Yes ®, No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo
❑ NA
❑ NE
a. If yes, is waste level into the structural frceboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 7j—
Structure 5
Structure 6
S pi I 1 way?:
Designed Freeboard (in): �9—
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�@ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
❑ No
[] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NI?
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S 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): �t_ �MUO_ /.9yz-rSr-rd/ / ���✓�t �!-t/Y��f
13. Soil Type(s):
l4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2LNo ❑ 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 ENo [] NA ❑ NE
�:,a Required Records & Documents
�"19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CgNo ❑ 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. [4 Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes a No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L&No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

d
. - Facili Number: Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C&No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
S No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
5jNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
2] 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 Co No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ®No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
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?
B-Yes
�Ko
❑ NA
[] NE
,del. - �m GUMS ��a � � �j ✓ eo
Fv r d90/4'
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
L
Page 3 of 3
Phone:
Date: /
21412015

Type of Visit: erCo—mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical.Assistance
Reason for Visit: 9-toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — H—I Arrival Time: Departure Time: � County: Region: .f=R 0
Farm Name: )�rl anzy��e,�'� 145� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1a r��j-rT7C Title: 42 Lji P" Phone:
Onsite Representative: ,S _
Certified Operator:
Back-up Operator:
Integrator: /Z-,X
Certification Number: �112 40�/_5_
Certification Number:
Location of Farm: Latitude: Longitude:
Design MUIrent
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
P.
Cattle Capacity Pop.
Wean to Finish
iry Cow
Wean to Feeder
DgrD
iry Calf
Feeder to Finish
iry Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Pqultr
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'Curke s
Other
Other
ITurkeyPoults
Other
Discharges and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes S-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: U1) 0"1
Spillway?:
Designed Freeboard (in): - — 7 4'
Observed Freeboard (in): 3 I _ 3 � 0 ,
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
'_V�o
[:]Yes allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[q-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?
ryes
[o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g 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
S No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ 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/y?t.r-7fJ1,r!ot
13. Soil Type(s): r !#(
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 g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes G� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [Z 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. ErYes ❑ N
❑ 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 S7 N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fo N
o ❑ NA ❑ NE
® Weather Code
.Z Sludge Survey
o ❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - jDate of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Imo. Yes
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge'?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility`? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes r" No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes 3 No
❑NA []NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question '#)s Expin1whily-YES answers and/or any additional recommendations or any other comments.
Usc drawings of facility. to better explain, situations (use additional pages as necessary).
7-0
Reviewer/Inspector Name:
Phone: �/M— _T.�ron
Reviewer/Inspector Signature:
ur• "'
Page 3 of 3
Date: & —,,;7q
21412011

ivislon of Water Quality r _
Facility Number ®- © 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: �ommpliance Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: (7 tcoutine 0 Complaint C) Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure
�/ Departure Time: . D_ County Region:
Farm Name: lrnr 1 ELK'/ d%'�"'� Owner Email:
1f 1 1�
Owner Name: !�-fYl -gsyG7 Phone:
Mailing Address: T
Physical Address:
Facility Contact: Title:Phone:
o
Onsite Representative: LQ Integrator:
i
Certified Operator: Certification Number:
r!
Back-up Operator: Certification Number:
Location of Farm:
if
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity 'Pop. Cattle
Wean to Finish
eanto Feeder 2L4000
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Non-L
Pullets
Other
Poults
Design Current
Discharnes 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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes UNo ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ Yes []No
[:]Yes 21 No
[]Yes MjNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
D Yes
Ug-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): j �]
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ 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?
JK Yes
U o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
C2No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
J�LNo
❑ 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. Crap Tme(s): /Z4 Lea . ac ��U,dS ✓a� ►_j Ke
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
Rqo,
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
K7 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Eig-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [3 Other:
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes FZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - = Date of Inspection: rrr —
i' 24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes allo ❑ NA ❑ NE
•i.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes [Z 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 ® 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
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 25 No ❑ NA ❑ NE
❑ Yes ,E No ❑ NA ❑ NE
[:]Yes
allo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[Eg No
❑ NA
❑ NE
❑ Yes
EE�No
❑ NA
❑ NE
Comments (refer to;question ##)s Explain any YES answers and/or any additional recommendations or any other comments.
Use dr,awins',tif facility,to better ex6lain situations (use additional pages as necessary)..
�Ct Ls,
�3
6_41t�s 0�_/ �C�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /6
21412011

V Vvs 0 rk5 Slob
b
19 Division of Water Quality
Facility Number ®- 5 S 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: l'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: WRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: Departure Time:® County:_
Farm Name: Fli''S RQje,►Cc±' Owner Email:
Owner Name: E&I 4&vevCfj+ _(kp6edl Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:, New Omit Phone:
Integrator: 11`1
Region: fQ
Certified Operator: i�V_i�IG{4�i C�� 13G'iCyCvV— Certification Number: �y4ts
Bach -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer Ell
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouits
Other
Discharees 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
Daig Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ® No
[—]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

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 [:]No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (4 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CR 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
to 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 en onmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
es
W[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
10 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑`�:� Ap/p�liicatiop_Out ide�o�Approved Area
12. Crop Type(s): COAA01 &M H 6 1 e SrMl "10&.[ - tp - [/1Vb rCY . SOy btoMs
13. Soil Type(s): l k_
14. Do the receiving crops differ from those designated in the CAWMP? Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 5D No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [52 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CR 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 171 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z) 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
2NA ❑ NE
Page 2 of 3 21412011 Continued

]Facility Number: RA- 5 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No
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:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document []Yes �R 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 U No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [$j No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes CffNo ❑ 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 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question #): 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).
4) TW 0 0 l It I Q O MS &A S' � .Tic we We
mo+� a, al e s �d>° . Th 2 �rOJ +�, now �iP�+ad)1►
�df {�� w H s01) mod. m S'- shelf
dh r .1�s cove -
bay f Mo jn 14�0t>7j , ©AS we
sow,PaL aid odf -.s � h.
i 9p I e_ do to f I -serf~ on � oT, aqj me bpi k1.
b'P'Pn S �tt� Q r F n1 v �t: �? � r111�s+ �
ir>e• a udM_
Chem ICd I Pe P / D l d ao�ao r3
Whene� oado1�I.s�yovmv,f 1091� �e ntfi3O�,
C4
has � `j p�►f�
ly)1VftJ_ new wea 4e p fry, f& scxjh v4, a7d pu I !s C&ve W * 9gmL dq_
� aye do?c beta Maer h) a o r y ,
hoed RRVta, k records,
NO MV6 PVAeJO haT � Alf,
o�,Cheof dw,
Reviewer/Inspector Name: ]0924s�17P�fr
ReviewerfInspector Signature:
Page 3 of 3
Phone: 910-y--3-33M (Oki �
Date: May .5 aao1
4/20l l

Facility No.
Permit COIC
F R nrnnq'
arm NamDatea- IZ I B e,
OIC N PDES (Rain breaker PLAT
Annual Cert Dally,Pipe)
Lagoon Name, 9 for'spillway
1
2
3
4
5
6
7
Design Freeboard. Last Recorded in
y —Dyckhad
0 bserved freeboard
--4o
Sludge SurveV Date
Sludge Depthi (ft
Liquid Trt. Zohe(ft-!. i !�r
Ratio Sludge to Trib trhe:nl tiWolume if> 0.45
Date out of comolianW POA?:.
0-11FTIZZ-1 [W-Thirrs1w,611 IF] rMT)INIIIII
1--wo �11
!ivy peF"
Soil Test Date T 1 767rafn.Id
Crop Yield ✓ Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed; WUP Dead box or incinerator
Lime Applied Weekly Freeboard ✓ Mortality Records
Cu-1 Zn-1 I in Inspections Check Lists
Needs 120 min Insp. Storm Water
Needs P MI 17 Weather Codes
MORI
"I.T.
TIR, I AM M.
ME �$
TIM OW I
WE MIMM"I'LMMITIM
Verify PHONE NUMB5Rjjand affiliations
Date last WUP FROFRO or Farm Records
Date last WUP at farm Lagoon # Wh.,_
App. Hardware Top Dike 5 5'P
Stop Pump 51,1
I I Start Pump 53 3
Conversion- Cu-I 3060= 108 lb/ic; 4n-I 3000= 213 lb/ac

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: . ,� [7 iZ Arrival Time: ; Departure Time:q0 W County: Region: PRO
Farm Name: 5w l HQ2PiCt1`H_ fiyp'v Owner Email:
Owner Name: FC/l 1fi/}{yCaf Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: [ rnr�r�l I Clur�rb-+�L
Back-up Operator:
Phone: 0� 19- 6(2 33
Title:
Integrator:
Certification Number: Qy4[�-
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Q Non -La er
Non-L
Pullets
Other
Poults
Design Current
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes 5R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ta No
❑ NA
❑ NE
C] Yes
'E�fNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: [Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes EjNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structgret 4,,.Stsruct`ure 5 Structure 6
Identifier: Id
Spillway'?:
Designed Freeboard (in): 19 1 q I q
Observed Freeboard (in): � s��
a
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?
RYes ❑ No
❑ NA
❑ NE
8, Do any ofthe 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 53:No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes CR No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application'? Ifyes, check the appropriate box below.
❑ Yes 5;�No
0 NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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
N No
❑ NA
❑ NE
❑ Yes
C-No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes -a No ❑ NA ❑ NE
❑ Yes ®-No ❑ NA [] NE
❑ Yes Callo [DNA ❑ NE
❑ Yes &4] No ❑ NA ❑ NE
❑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 nkNo
23. Ifselected, 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

Facili Number: -
Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,�J-No
25. is the facility out of compliance with permit conditions related to sludge? Ifyes, 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 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes 5-No ❑ NA ❑ NE
❑Yes '@No ❑NA ❑NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes ' o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes R No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes �No ❑ NA ❑ NE
V J[:^ULA}\III�J. VI ��cuuv..w;��cuccv�cxtiiau��nuauuu�_lutctxsuuuivuai;Nu�w�.a��uccc�Ja�J'.h'..:' E':,'f ,l,..� .•fir= ".'�. .''e� k- '.'
-7, p leose-work 0,1 b;e s &I !a tx� I , Mped-• seed 0/ � rr ry
Sal r fP ' 1r ,Yn� bra h 1�ac g rov add * 1 c Goo U��
YvO D, on 0Aj- de Ipyc , balks LAct CjeAJ o�•� VvO /�� �
y� � y
C�ln�r,
& -Two o d Vn 1/� � �!� �� �e b�irr �0�� � h��"n , der has c�
gU � �,�c�d2�i 4a e_ � h ha�L t�� .
e/1de e s ti . This n j b rnark��
ea a so! str�l
T�is nere�� be-�1 �� h cl� %�
[s� C�.((d1 Yvoe i aba--a Y(604 ayo, f
Slid 6Jy,�P
No fofir�has b�, �c�esi'�ce_ delo6&-aoi dv�e 0� keat v_ cnd
�ffi[i We >~ � �! be h saskv, D'1 sone- -� eld r, Nose have wa��
/y� �1 Jy�/Jpyy��'q�,p .say-� r '(or- level,- ' a�od �� © y Ms
[.
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 o, f 3
Phone: -tt&VjV _ 3300 [ffict
Date: ao
1412011

Facility Na. ��—�� Farm Name d+Y' GV Date /I a.?
Permit 5COC OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
FB Drops
P i P
Lagoon Name, S forspillway
1
2
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
-
o?
Sludge Survey Date
-Sludge De th ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
.. _ . _nm■©©�©���
Soil Test Date ar
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres �—
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied D
Cu-1 v Zn-I ►�
avOlt
oeh
Weekly Freeboard
1 in Inspections
Mortality Records
Check Lists
Needs S (S-1<25) �-
120 min Insp.
Storm Water
Alaaric P ✓
Waathar C.rviac
`
■—.
l.' AMA!
. ,
/
G
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
3`
5 5�
App. Hardware Top Dike
5
Stop Pump5ty
Start Pump 33. j
A > ,/
Conversion- Cu-i 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
r�
..)r-r11 } j

�60'Division of Water Quality
Fikility Number $ a - .r� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: WCompliance 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 0 Denied Access
Date of Visit: Arrival Time: ; Departure Time: County: Sjjrij9_ Region: _FRO,
Farm Name: CC* Ta/01 Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:3a)y k,
/ i v
Facility Contact: C ] Q^k C`c Title: 1 1 Qil
Integrator: L2
Certification Number: OgV17
Onsite Representative:
Certified Operator: Ly r1UQ 1 l C, UQ*tA
Phone:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer jQ Non -La er
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Design Current
Cattle Capacity Pop.
Dairy Cow
DairyCalf
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes S] No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
[:]No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

[Facility Number: 113ate of Inspection: T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�rNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Z
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
['j 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?
[�j Yes
VTNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Zj N[ 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
C-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
5'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 Approved
Area
12. Crop Type(s):
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
j No
[] NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
IS No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
Yes C No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes f�[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
E"NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: -711
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes 50 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Ycs ® 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
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 [3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes b;rNo ❑ 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
®No
[DNA
❑ NE
Comments {refer to question #): Explain any YES answers and/or any additional recommendations or any other comtr�ents "y " "y
i1"sc drawings of facility to better explain situations {use additional pages..as necessary).
7, Ifeer Nor kl Ord ba-e s
. rIf in cct' � O"q-h iPmb1' o-d coalP 4vt weed a-ez ea'-
mat i 615 v,_
b."o r'
pq; �Vi 11 nfed_ Ca(! blawan I A o
a5, -f'. o la cols ba,,.e 16 Iffc4V ` 6a_P1t7, �Ve / O'le Is abv-* gT110
w n�t°a� � J eana4 in 0 few
a�� 1 yelcu ,
1?,-e1 3000 M_ are Plea+ Of- yvOJ�e ����,7heie-
haa� s� fit? Wad 01 _h1041 'V 1+-e �Q,*, �y a� Guir� . ot-�u�d� PjAllle
�lp��tfr nUT n�'pn pod f(� e. )nt -�71 j Ot w- D I0 w n vrnbe1 al eIla5 ad dlo�f ,
Coo record_j oJ_ hell rn k6er cCt `ECM .
Reviewer/inspector Name: So04 �� ceI
Reviewer/Inspector Signature: %'
Page 3 of 3
Phone: 91" 3,3— 33M l Lm/
�
Date:
2/ oll

Facility-Nd.S�`77— Farm Name
Permit COC
Pop.
Type
Design
Current
Date
607 62
0-r -
■ -.. mm
--�& �lao
Lagoon 5
1
2,10
3
4
5
6
7
Spillway
IP-I&Mj
Design freeboard 6 6-)
Observed freeboard in
3
6
Sludge Survey Date
Sludge Depth (ft)a..
Liquid Trt. Zone (ft)�.
R do Sludge to Treatment Volume
1 T �a�ii i i lVl ' 7g,!WKllf
Soil Test Date 111fl Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed 0 Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-1 v,�n-1— t : 120 min Insp.
Needs P Weather Codes
Crop Yield Transfer Sheets
r _
-■
_■,
MrOTUM, E..
..
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records q1 101
03
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 iblac; Zn-I 3000= 213 Iblac
App. Hardware

IDS OTT 09110
1 W Division of Water Quality
Facility Number �i� Division of Soil and Water Conservation
__ ----- 0 Other Agency
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: 1 Q1 Arrival Time: �� Departure Time: County: Region:
Farm Name: Eyl Ho),P t Cct� Ram Owner Email:
Owner Name: &(rl 1 I0eyey* Phone:
Mailing Address: 1:7(n So am (4
Physical Address: ,��� , I Malmo,
/
Facility Contact: 1� C'. ! TEi�li U Title: atmi9^ Phone No:
Onsite Representative: l k& [(Jii i Integrator: H_ 8
Certified Operator: l n ��yC Operator Certification Number: @ qyt 57-
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o [= 1 =66 Longitude: = o = { = of
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Cur"rent Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
90gAo Imo! ��� ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turk e s
❑ Turke 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ 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?
❑ Yes N No ❑ NA ❑ NE
❑Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes IS No
❑ Yes allo
Page 1 of 3 12128104
❑ NA ❑ NE
❑ NA ❑ NE
Continued

Facility Namber. — 157— 1 Date of Inspection LLiILCL.LJ
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 I Structure 2 Structure 3 Structure 4
[]Yes 15JNo ❑ NA ❑ NE
[:]Yes (]No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in): 19 _ 1�
Observed Freeboard (in):
tj
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
N 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
Wo
❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[NiNo
❑ 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
[5�,No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
iF;�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (_vQSia i �P/m✓lll_i f&,► 9-Pose ° .Brno!! Gin;, r9VeiA ll ' C �n
13. Soil t e s) Veolk f
YP (
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5Tio
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0? No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tgNo
❑ NA
❑ NE
Pii'!-f �r.i; !'`#f3 M
Comrnents!(relerlto question,"#) Explain any YES:'answers and/or any"recomm` endations or,any other comments
issa' j •" - , rY{•.
Use drawings,ofFfacility to better ea plain situations: (use addlttonal pagei as, necery)_: , ; s
E �G Ak `r.:+-.. �k�k xkxt
A
Reviewertinspector Name �'' ��,` � ;'
Phone: 3DQ
� a
Reviewer/inspector Signature:
Date:
Page 2 of 3 V 12128104 Continued

Facility Number: $ a --S Date of Inspection []
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [5jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IRNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design. ❑Maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 JRNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No MNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Clio
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ 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
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
R 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
ERNo
❑ 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
r3No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
tNo
❑ NA
❑ NE
, brai `Ti 1,ej­fvo-ro k nolvr) AL
-it YW[ 11� 0 On i ayoms f a nt;C , Neo e _0Fi?%,9 hrk
� Imp qh COrrlfns 0 L a s' a one 3 _sAad � ra.�_, g Nea e- C (
brash CO�n�r' ©f`�ooh`y 0 y ,21
15, Prod U(fnih,ihks 16 � mar q � lied 4n �uIIs Of)e_ n Wed in AAp4 1.
a)+ dot I +e.st a,oLsl�dy�swvP rat�C.dote���q�l
CQAt wlII be. h y
ni h .-X,1�c,I -eve Is Yvff PP, across A/C-,?qj Or d
ne i( wp,k QJUE U parsl�d L a f Iirdbn , n f U
I, pne. layno� a b h I � s[� Ra•ho= �s o s rdy� Iigt,faC*4>11*i - vot�t�,
Weft moi*afW -&m 4 goat recoils , .
Oowol node a4k, W- &I f0d Uct Cott] IVil
Page 3 of 3 12128104

.1.-r ( l
Facility No.` ;)-55- Farm Name _ Date 1
62
Permit,,, COC 1/ _ . OIC - NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
Design freeboard
Observed freeboard---�--
.. -6'11 IFF-Tyl 9 . I
Ratio Sludge to Treatment Volume
gow.. r,,
45 000r q l "1 fu Ii� in s 1
Soil Test Date 10 1 6a Wettable Acres RAIN GAUGE
pH Fields 5t WUP Dead box or incinerator
Lime Needed 1WI AI C ' Weekly Freeboard Mortality Records
Lime Applied _ / 1 in Inspections
Cu-I Z111-1 120 min Insp.
Needs P %4q-"7 Weather Codes
Crop Yield �! o b" COyn— Transfer Sheets ✓ 3 L
' 000 Gal)
Own M..
..
IS
'J'11►�
r ►
�-
1
1
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Qijp1a3 Date last WUP at farm
FRO or Farm Records
Lagoon # 33,Cb
Top Dike
Stop Pump 15tr
Start Pump 53,00�'
5
App. Hardware
7
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac
YAW W,nc d Ir, 9ov, QYo nor ,k

Mql aw R(a lq(.31oq
r
0 Division of Water Quality
Facility Number �a _ � 5,5 0 Division of Sall and Water Conservation
— -- — 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
r
Date of Visit: n1 Dq1' _ Arrival'Irime-PNOM Departure Time: .3 County: � Region: `
Farm Name: C(Af I T'1ffXTf4Ct•�[ i�f1h Owner Email:
Owner Name: L. LL1I'fL Phone: ---�,p
Mailing Address: 20 BQl (7L barzi ge
Physical Address: j
Facility Contact: C ��/� t7 r Title: N0&*1E Phone No:
Onsite Representative: Integrator: Ew-hr—Plow„
r /
Certified Operato Operator Certification Number: AWA a 225—
Back-up Operator:
Sack -up Certification Number:
Location of Farm: Latitude: = e = 1 = {1 Longitude: = ° = 1 = 1{
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Other
❑ Other_
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ 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?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9"No
❑ NA
❑ NE
❑ Yes CRNo ❑ NA ❑ NE
12128104 Continued

-•
Facility Number: 7.— Date of Inspection
Wnste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'RNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stricture I Structure 2 Structure 3 Structure 4 Structure 5 SiruCturu 0
Identifier:
Spillway?:
Designed Freeboard (in): I q
Observed Freeboard (in): 3__ �3
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N_ZNo ❑ 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 environment4ll threat, notify DWQ
—41
7. Do any of the structures need maintenance or improvement? N Yes R No ❑ NA FINE
8. Do any of the stuctures lack adequate markers as required by the permit? §VYcs R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes KINo [I NA ❑ NE
maintenance or improvement?
Waste ADttlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C}No
❑ NA
❑ NE
maintenance/imp'rovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
OKNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift[:]Application Outside of Area
ie 6 OS ` %Y l S
12. Crop type(s) Q20A41 &9A JQ J
TO
1
13. Soil type(s) NOA is
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
WIo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
tj No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
NJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
�jNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5kNo
❑ 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 A1E[Phone: rl0 233— 3Q
Reviewer/Inspector Signature: Date: 76k4JO a
122/28 4 Continued

IL
Facility Number: $ a —� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available"? ❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Jj;-No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q*o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
t�-No
❑ NA
❑ NE
23.
If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
❑ No
UNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
tRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
t@ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
'RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JR 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 concerti'?
❑ 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
gNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
eNo
❑ NA
❑ NE
AdditionaC Comments and/or Drawings:
PI "f. ),ee f fmgch i� I !jooi boy blo' e sfdH with old- hQ
nl%fake Wei, t.&ha Omb (,-fyef) bast IiAwo tS�`l Q G9n l
Plea e, cl>ea, ur wood 9roP f) aramk f alten treelrwrk I jade
sfi,a 7 1
(0 , One afbcJ� *ed I a o lle ov,6, -Cron Ia7os
sGjylt Chd 1 'R Vre TG S A,
vVI/ q-
Gvo n aSn�4 re(ordr Dk,,ena��.
ft
�a�ifi ca 'on no�o� iOdlL4el� Cod
Y
Page 3 of 3 12128104

` Facility No. 'a� Farm Name CLI Datea 0 ��
Permit ✓ COC s✓ OIC-L-` NPDES (Rainbreaker PLAT Annual Cert )
_ ...
.
---_--�
Design - - ....
---�-_-
Observed freeboard
Sludge Survey Date
ISO mo,
Sludge�-
Depth (ft) : 0/0
O ■I
rwT�F
ti.ALI
Calibration Date
Design
'
-------
-
------�
Soil Test Date alg
pH Fields
Lime Needed U1104t7
Lime Applied
Cu v Zn v
Needs P__
Crop Yield
Wettable Acres.
WUP
Weekly Freeboar
Rainfall >1" ✓
1 in Inspections
1nk6(ff-
Tlaste Analysis Date MFi%gPj!!ilFlli��t�l�'
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
n r '
I Vs...r
��.� ',...! ,
� of
•a '
�
����INS
Verify PHONE NUMBERS and ffiliations
Date last WUP FRO qW
R� Date last WUP at farm
$9. Farm Records
Lagoon # 11"���YY11
D
Top Dike
Stop Pump l
Start Pump �� 0
App. Hardware

b145 12K13r03 UV
Type of Visit WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 12Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 J Arrival Time: ��3 Departure Time: County: __54"X& Region: FAO
FarmName: Owner Email:
Owner Name: i _ �yt Phone:
Mailing Address: To hz
y 1�,] SL166'/nj
Physical Address:
Facility Contact: 3.�l & k fyr& Title: FAA, Phone No: r C
Onsite Representative+: C l&-k 'l-4t Iey Integrator: i1LY1±l�t-D�QN'►�„ LL,
Certified Operator: ` G HDlj?fcv+ Operator Certification Number: ]T 'A c) gitS"
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =e 0i =44 Longitude: =° =A 0 f1
Design Current
Swine Capacity Population
10 Wean to Finish
U Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dair 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: EJ
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
■1
❑ Yes I'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 'tRNo ❑ NA ❑ NE
❑ Yes ISy o ❑ NA ❑ NE
12128104 Continued

Facility Number: g a 5 Date of Inspection LLL�I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes
[:]No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): IQ
Observed Freeboard (in): 33 3.3 3{0
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 arc not properly addressed and/or managed
❑ Yes
H 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?
R Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
ERNo ❑ 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
NNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[allo ❑ 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) CONH # Affnl 4A ( fW 4> POI-kv/P ) '. C EaA , )V eaJ1.349YbeA f
13. Soil type(s)-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
SNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
C,No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
t5jNo
❑ NA
❑ NE
Reviewer/Inspectnr Name Phone: TO 1-33-3330 k3333
Reviewer/Inspector Signature: Date: wI3ila
Page 2 of 3 12128104 Continued

Facility Number: Sa Ss Date of Inspection [
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes RNo ❑ 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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 JK No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IRNo KNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
26. Did the facility tail to have an actively certified operator in charge?
[I Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
15�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo
❑ 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
9No
❑ 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
CE�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
R-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
51No
❑ NA
❑ NE
Additiiinal Gorrtments ati"d/qr Drawings �, 1, '';
OAf-k&e, co,-•1er 0-0 Le r, Ktep m,11cAh areedih�f Mo c of o�-hogr�
40 ry;,4)h& e;1
M � Ctege S, 1d_
M a►-�of 1 a�oa, Co-4-
j ar i eyj 1N9 i �rn ft�
s,Yvf war dote i,e) tiecaAo7, V01 b__ repw`fhlr Vcd1,6t�-• , S'Jlldje3 P�
huh - L#j I ) eveA -1Uj, 4 r+ wa.r pmpOC 0OH"n 30o-7 (a to j L & a� ,
�H, Calf bojed )oowl will be_ redone, -Wr -Poll b7 001 13al
�1 ati�ed r +h I.r rn on , Soyk�;,f nv+ ha-voi lek
Goat ao� � `�dlm a rf(j)rds.
S�OrCI eaL )r 1 try- IiPn Aviv-4 a)Pui U 1— y .
Page 3 of 3 12128104

(0)
Facility No.ja S- Far ame i'P C Date i lf�g
Permit f COC OIC_ NPDES (Rainbreaker PLAT Annual Cert)
NORM
.. - - .. - Perm Liquidsue
Tfih*Ar%-o-h1r 4YP %;OA51L*# VVq
(e� o,f
•17-
� '-------
r,;
SoiI Test 101aO for
pH Fields pH Lagoon a
Lime Needed fit
Cu ✓
Zn ✓ f1 S�ajft�t�
Wettable Acres
Crop Yield
Rain Gauge
Weekly Freeboard _;!
Rainfall >1"
1 in Inspections
120 min Inspections
Transfer Sheets
AIV We, O,4r iA 11v1 --30- 1, o « '"W. ' �W 1VV V I M ! ' F8.14, kI �P yiarop3 s9t a I
Pull/Field
Soil
Crop
Pan
inKo
befookr
r SG
JA
oft
Vtb 0
$
Sill 51-1
",3 !13.3
— 6Mlast? I
2WO
'i.0

9 I M5 I�A4 o-? 0_1'S
acuity Number
Division of Water Quality
Division of Soil and Water Conservation
0 Other Agency
Type of Visit )U Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (;Ztoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: LLL� County:
Farm Name: ' f Owner Email:
Owner Name: cl ci. V Phone: _
Mailing Address:
Physical Address:
Region: eo
Facility Contact: f Title: rr 11 1 Qry PhoW
e No:
Onsite Representative: integrator: - 111ty) m
Certified Operator: Operator Certification Number: o
Back-up Operator: Back-up Certification Humber:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: 0 e =1 0 Longitude: 0 o= r=
16
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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
❑ Daia Calf
❑ Dairy Heifej
❑ DEX Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F31'
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No "P NA
❑ NE
❑ Yes
❑ No ,N�NA
❑ NE
❑ No 8 NA
❑ NE
❑ Yes
❑ Yes
P(No ❑ NA
❑ NE
❑ Yes
❑ No VNA
❑ 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 XT o
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [Plo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z &\?eed iiTfs
jai)jio Jt/S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes IgNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
Xyes VkNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes )4 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks andbr wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes E)PNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
l , Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
� Cr UJC C W -S
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�X-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
IR 'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[VNo
❑ 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):
�} tip•, r• o tA�� Z O"�' U�p�f S V a iniro
6� MQ-t � wa'4- V S. t � �r� ,
.Z�4 areas . SO,-np eyes "on &Wet -tu C-101
NUFco;
f ces+k� G-A co ver .
Reviewer/inspector Name /UL0
Phone: oa
Reviewer/inspector Signature: ZL
Date: CEC--
12128104 Continued

•I Facility Number: = —O Date of Inspection 1 to
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JkNo ❑ 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. ❑ WCP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 9No ❑ 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
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
; 1,NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VkNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ej No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1�2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
6NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
QgNo
❑ 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
h'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
]�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
12aVO4

Facility No. \ Cl— Time In ✓ 1 ' Time Out Date Z l�
Farm Name �.CLX Integrator
Owner 1iLCL A c Site Rep
Operator C4_nAU u No
Back-up
No.
COC Circle: er or NPDES
Desi n
Current
Design
Current
p
Farrow — Feed
can — Fi
Farrow — Finish
Feed -- Finish
Gilts / Boars
Farrow — Wean
Others
FR Design
Sludge Su G
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Obsery d
alibration/. M
Waste Transfers
Rain Breaker
PLAT �---
1-in Inspections
Date Nitrogen (N)
Pullneld
Soil
Crop
Pan
Window
d
C r

Type of Visit *Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint 0 Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: q—O/ -Q(p Arrival Time: Departure Time: County: S 0A/ Region: Flex
Farm Name: Zr2,116-1[? wCv �dVltil Owner Email -
Owner
' / l0
Owner Name: /7t/Ne6f C 7T Phonz-
Mailing Address:
Physical Address:
Facility Contact; Title: Snr e1�' Phone No:
Onsite Representative: C (aac . Integrator: Piz, i lr.�e .valc�.v
Certified Operator: -� 1 !�� 44y Pj" e: J. ++_ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = « Longitude: = ° = 1 = P
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capty Population
❑ Wean to Finish
Layer
❑ DairyCow
Wean to Feeder
era
Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
I
❑ Non -Dairy
❑ Farrow to Finish
La ers❑
Beef Stocker
❑Gilts
Non -La ers
❑Beef Feeder
❑Boars
Pullets
❑ Beef Brood Cowl I
Turkeys
Other
❑ Turkey Pou Its
❑ Other
ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, 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 M No ❑ NA ❑ NE
❑Yes �No ❑NA
❑NE
❑ Yes No ❑ NA
❑ NE
❑ Yes [P No ❑ NA
❑ NE
❑Yes No El NA
❑NE
❑ Yes No ❑ NA
❑ NE
Page I of 3 12128104 Continued

G
Facility Number: $z—
Date of Inspection —O D
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 Structure 2 Structure 3 Structure 4
Identifier: J_ Z 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z I �i top
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 managemenfor closure plan?
❑ Yes PQ No
❑ Yes A No
Structure 5
❑NA ❑NE
❑NA [I NE
Structure 6
❑ Yes O No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement`? ❑ Yes VINo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes ;n No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes %No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ YNo ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.) rr
❑ 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. Croptype(s) 5md tsral"v 62VWs'"i } Jutti �Pa,� .-e_ .l Coe"
(GM
�r
13.
Soil type(s) / a
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
f No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
;gNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
PONo
❑ 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):
Iry
Reviewer/inspector Name Phone: .3j' -333 0
Reviewer/Inspector Signature: Date:'—Q/—ZOQ
Page 2 of 3 12128104 Continued

Facility Number: Sz —SS] Date of Inspection 9—CV—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[WNo
❑ 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
( No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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
�gNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O referral O Emergency O Other ❑ Denied Access
Date of Visit: 2 1a 0 Arrival Time: /Q : OQ DepartureTime: i � County: S4vKje60-vt Region: FP_0
Farm Name: LtrikDrtP�V'+ Ea" ,-jnA _ Owner Email:
R'-1 He 0 U TT Phone: 9!U -- S25" YS2(e
Owner Name:l
,Mailing Address: _ PD Qo x / (Q SR 1 e�,a 10 v f_r4 N L Z B 3 8 S
Physical Address:
Facility Contact: _CApeE:ti- C{a1&r+µ4d _'ritle:
Onsite Representative: __CJok r_ k= H f7" n:• e—try
Certified Operator: �9 GfAX �L
Back-up Operator: qO t t4N t.,N'
Location of Farm:
Phone No:
Integrator s F
Operator Certification Number: ZYY S
Back-up Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Population Vet Poultry Capacity Population
❑
Wean to Finish
Wean to Feeder
I L709 D
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Other
Poults
Disci & 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
E:I-Dai_ry
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?
❑ Yes XIo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
�Vo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection z v a
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 s�freeboard?
Structure 1 Vucture 2 Structure 3 Structure 4
Identifier:
Spillway?: NO /ya IV O
Designed Freeboard (in): (7 (� _ f
Observed Freeboard (in): �g� %� Z Z_
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 OKNo ❑ NA ❑ NE
[]Yes [:]No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes 0,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? ❑ Yes K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ 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 14No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q%No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes JNo ❑ 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) TLa r •n 5 wtaU d rep% A , Qec-r� �r�c�
w,t�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
91No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Dg�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EZNo*
❑ NA
❑ NE
ye4' w4x-�- r Sei- 4cm- oo-., 44 3
.tPc�a "V'P-F 0--A- �� e o ,. of
Reviewer/Inspector Name(':f Phone: 910— y�l(v-lSy/
Reviewer/Inspector Signature:.. Date: Z f )ozoS
12128104 Continued

A`�_
'�f
Facility Number: 82- —55 Date of Inspection 2 t e 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PI -No ❑ NA ❑ NE
20. Does the facility fail to have all components of ttte CAWMP readily available? if yes, check ❑ Yes D3--,No ❑ NA ❑ NE
the appropirate box. ❑ WUP- ❑ Checklists ✓❑ Desige"❑ Map ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes VM ElNA ElNE
❑ Waste ApplicatiortPT-1 Weekly Freeboartr[] Waste AnalysiS"�❑ Soil Analysi`e"❑ Waste Transfers ❑ Annual Certification
❑ Rainfall✓❑ Stockingle ❑ Crop Yieldt*�❑ 120 Minute Inspection ❑ Monthly and I" Rain Inspectiong— ❑ Weather Codes
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 off ice 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
MLNo
❑ NA
❑ NE
❑ Yes
❑ No
Ej0gA
❑ NE
❑ Yes
Z+NO
❑ NA
❑ NE
❑ Yes
R+No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
-.No
❑ NA
❑ NE
❑ Yes
Kjslo
❑ NA
❑ NE
El Yes
2CNo
❑NA
❑NE
❑ Yes
P�No
❑ NA
❑ NE
❑ Yes
2 .No
❑ NA
❑ NE
❑ Yes
V5-No
❑ NA
❑ NE
❑ Yes
C5No
❑ NA
❑ NE
Additional Comments and/or Drawings: "
Z R. L4 a k- avex- 1r�¢.d.� re, O'k t 34'r G %,-4 r QLr� + C c y e l ai
W,-st— 17-110toK %-s 4/i910'1 Z.
glL310q 1-8 Z/zo�oK z.3
(0/v /041 a .1%
26. Qec,e� +ice i veo tnevj W V P --b
K etc-r- >Lt-p-S aPpl; c.._ O--, ci s
ZS . S J co-vj J dre-s� Socs�
12/28/04

Type of Visit &�Lompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: � Time: ; oa
O Not Operational O Below Threshold
Mfe'rmitted EP[.ertifie d[3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
HFarm Name: ..... &ki...... oew7c.wff..h�r.........- County:... w Rh»...........»,............»,..». ..... .................
OwnerName:.......?-rpl,... t !t4................................... ............... I...................... Phone No:.....5 (o.T..'.5! i.°Z................................................
MailingAddress: ...... f..,:........ ,...... ................... ...................W................................++1.{4+!{!t..;....,(x....................................... A$....
Facility Contact: .....lu r1K....AW4 cu++.........................Title:....12S)! I A......................................... Phone No:.............`......................................
Onsite Representative: ..ti.r rk........1.4P4 ex ..............................................- Integrator:.... . -w..... „,ct�r ........_..................
Certified Operator:..4r1�f1. ...............»............k........ .................. _... Operator Certification Number:..........................................
Location of Farm:
..
[Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 G6 Longitude �' �' �"
Discharses & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 01 o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made' ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
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 [ifio
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes G;,Ko
Waste Collection & Treatment �,,.�
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes L�'tvo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................. I 3
................. ..................... . ................................... I ...............................
Freeboard (inches): Sk a S
12112103 Continued

Facility Number:
Date of Inspection 9 a
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [914o
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 Q<10
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes YN0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes La"No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes E�No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes O No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop hype 3er~Ja • . SK-411 ,rxih
13. Do the receiving crops differ r ith those designaMId in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [Rlgo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
2No
b) Does the facility need a wettable acre determination?
❑ Yes
Olo
c) This facility is pended for a wettable acre determination?
❑ Yes
ErNo
15.
Does the receiving crop need improvement?
❑ Yes
[l'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
EErNo
liquid level of lagoon or storage pond with no agitation?
I &
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
MNo
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[2No
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.
.t i.n : i:t;i;^ -,Hh11 o4Fk::S;Y'`.9,,.f11_:Lt"" •Epr71L!h",-:.;I,iti::N;tiati.w tli: �) •:-f'34-,r!i..i�sr`ilW �!J�rti �.iuc .�.:. �.1'£ ,� 1�-1 mi9 ts. i S I - � !.,It
:Comments(refer to question:#)s. Explai>1anyYES`answers''and/or any recommendations ar anyiathercomments1,!i ;f
y!riC.'' fY'3rN 't1^�':11:i4iws S'yiu li i.:a il%iiNillifra I'- ul £i -it Ss w t!nlii!f :".?IbRSI''h y' id'4dFSli idl !U uiShli:C>i"`
Use drawin iof facilt to,better ex lain situations /use addi#fonal a es as;necessa 14 11li
.£N S h: i:'j`� r i ! U,°.: lei1 1'11, �, ,S ya IT r ;�r , .r�i ,,'t leld Copy ❑Final Notes t i
law � . � ; �1 � C a� .w z . !� Jff ',Jjjj� �. €
A,
N Reviewer/Ins ector
P
Reviewer/Inspector Signature: Date:
12,112103 Continued

Facility Number: Date of Inspection MEE
Renuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes O' o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes [+'No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Rf4o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[91 o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[gfqo
25.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Ef No
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
Ek-f4o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
ERfgo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[9,f4o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
9<o
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall [:]Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention:
Facility No. _ 8a ;ss7 _
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: August 1 , 1995
Time:ia'sA
Farm Name/Owner: Jo g
lWailing Address: P, 3 NC. 3 $.s 4 s` -S
County: Susan _
Integrator. Dogwood Farms, Inc. _ Phone: [phone] ext. 316 _
On Site Representative: csLyi nngwantj Zarinp, Phoneksu n) .,5.n9_7i n4 _
Physical Address/Location: rc • C 2t
Type of Operation: Swine x Poultry Cattle
Design Capacity: .S 40C Number of Animals on Site: S &cj o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:_O.E ° ' Akm Longitude: ° _a, 2.3 0
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 23 year 24 hour storm event
(approximately I Foot + 7 inches) le or No �£Frereeboard:_.-Ft. -Inches
s«
e
Was any seepage observed from the lagoon(s). Ve�s or No as any erosion observed.- Yes or
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No (Not Evaluated)
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin L? I&or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or I1&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No (Not
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other Evaluates
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,(Not Evaluated)
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:_ This war, avery breif ins ep cr;rm,� aimre tharn„gh inspection will he_
condugted in thg future.
Information noted on this inspection was obtained from the intergrator or agm files_
If you have questions regarding this report please contact Paul Raw 1. DEM Water Quality
Section at [phone].
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.