820164_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

lj G
Division ofWater Resources
Facility Number JLC - /lad/ 0 Division of Soil and Water Conservation
ILI
+0 Other Agecy
Type of Visit: Urol=pliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S/ Arrival Time: i Departure Time: : 3D County:r�� Region: ? ` D
Farm Name: Owner Email: __�'"
Owner Name: _`� y�7�rL��l _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 Lf yd j 1 Title: Phone:
Onsite Representative: !Lr1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: !f
% 2
Certification Number:
Certification Number:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
I INon-LaU
IDairy
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
Dr. Poul
Ca aci
I'.o
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turke
Qther
Turkey Poults
Other
Other
Discharges 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?
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 To ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
Io
❑ NA
❑ NE
❑ Yes
l—T o
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
❑ Yes
[�No
❑ NA
❑ NE
Waste Collection & Treatment
•
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑
[] NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 54 C
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 --Ko
❑ NA
Spillway?:
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
I3"No
❑ NA
Designed Freeboard (in): ` 1
the appropriate box.
Observed Freeboard (in):l�
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[31�o
❑ NA
❑ NE
waste management or closure plan?
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
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?
�es
[to'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ETNo
❑ 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
U <o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3-&o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 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): u C-
13.
13. Soil Type(s): g D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�la
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ l No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 --Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
I3"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
E] -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
Q o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

• Facility Number: -16q jDate of Inspection: —
0-5o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[T No
❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�10
❑ 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
[3-1�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ErNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No
[ ] NA ❑ NE
and report mortality rates that were higher than normal?
24. 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 [i]'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [D No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
0-5o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
go
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[21G
❑ NA
❑ NE
Comments (refer to question #)Ezpfam,any YES,answe..rs.andlor any additional. recommendahonstor any�other cnenments. E �l
Use drawings of facility to better a lain situations use'adaitional a es,.as necessary). �
g ty%P [ P 15
VD cl P.�j� � CO h-1 r/G�
rol 7�s Yo
Reviewer/Inspector Name: Jac �TG��j_ Phone:y�-3�'✓^ptS�
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/.2015

Type of Visit: E)'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (D tcoutine O Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: G-/ ] Arrival Time: t? Departure Time:%jj��/� County: Region: ?r -Ta
Farm Name: %j4 -1j 7-yy? )(,- Owner Email:
Owner Name: j� i I / r ���� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: ; /4y `rys, Title: 4}uJn eV Phone:
Onsite Representative: 5__-VL�_
Certified Operator:
Bach -up Operator:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. 1s 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 E] No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes No
❑ Yes No
❑NA E] NE
E] NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued
yD sign Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Poul
Ca aci
P,o P.
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
., .:igg11 Turke ys
- Other
"�'
_
TurkeyPoults
Other
I
I 10ther
Discharges and Stream Impacts
1. 1s 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 E] No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes No
❑ Yes No
❑NA E] NE
E] NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
/G— /
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: 3 G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[-]Yes
allo
❑ 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
E[ 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 DVM
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
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
IqNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s): -el h)
13. Soil Type(s): i{JQ,T /' `Jo
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 13 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes allo ❑ 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 R No ❑ NA ❑ NE
❑ Yes U�jNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes fKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Q�_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 RNo
❑ 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 IkNo
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 21412015 Continued

' Facifi Number: jDate of Inspection:
.0 24. Did the facility fail to calibrate waste application equipment as required by the permit?
E] Yes
Co No
NA D NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
fa No
NA D NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
D 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?
D Yes
C3No
DNA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 Yes
0 No
[] NA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:] Yes
® No
DNA E] 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
[R No
[:] NA D 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
E:] Yes
Ca No
0 NA D 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
allo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
E[No
D NA ❑ NE
33. Did,the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Yes
allo
0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
allo
❑ NA 0 NE
r "_�, .
Comments (refer to on # 4E Taut an YES a r ' ry) Mons or any other cowmen
Use drawin"sof f. iii to;betfer e.z�lain situations (use ddtho aI P ga ommenda$
� tl XF Y Y €
5
ReviewerlInspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: 2;,e
Date:`/6_717
21412015

Ii ype of visit: w_-mompuance inspection v [operation tceview %,j structure nvaluatton tV i ecnmca[ Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: Departure Time: County: ��—
Farm Name: 7_y.,? o4t1 Owner Email: —7
Owner Name: ! Phone:
Mailing Address:
Physical Address:
Region: jr-1—
[]Yes
r-1—
Facility Contact: ZJfly %/yh2�l Title: Phone:
Onsite Representative: Integrator:
Certified Operator: S.• -r Certification Number: 2�.�3�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Capacity Pop.
Wet Poultry
Ca
Finish
La er
Dai Cow
17FFarrow
Feeder
Nan -La er
Dai Calf
er to FinishDai
Heifer
to Wean
Design
Current
Cow
w to Feeder
D , P,oul
Ca ac'
Po
Non -Dairy
row to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
ars
Pullets
Beef Brood Cow
k1lGilts
keys
here
Poults
er
10ther
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 [E.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes []No
[:]Yes � No
[:]Yes Ga No
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

FSciliNumber: - Date of Inspection:
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
p Heavy Metals (Cu, Zn, etc.)
.2aste Collection & Treatment
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JZ 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
❑ Yes EA No
Identifier:
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes jeallo
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®,No
❑ NA
❑ NE
acres determination?
q
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[allo
❑ 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?
JCZ
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
[DNA
❑ 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
p 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):-/rrl���� d1trs�t�(
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes EA No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes jeallo
❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes GjNo ❑ 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. ❑ Yes 2 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 Eallo
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Fieftity Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J. 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:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [ANo
❑ Yes [allo
❑ Yes El -No
[:INA ❑NE
E] NA E] NE
❑ NA ❑ NE
ConnmenN (refer #o question #) Explain any YES answer and/or any adii�bonal recommenda#ions or any other�camments.
I!
Usedrawings ofifacthty to hetter:e Iain situahoas'(use,.addzhana!€pages:as necessary}.
�.;:..
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 7_4P:�f ,3300
Date: &
21412015

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,'N Departure Time: County. Region:
Farm Name: b 75"nAt l parr► Owner Email:
Owner Name: TTr dao Phone:
Mailing Address:
Physical Address:
Facility Contact: &/_T�'Hd .c Title: a7��, ror _ Phone:
Onsite Representative: sw,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design
Current
❑ NA
Design
Curren#
Design Current
Swine
Capacity
Pop.
W.et Poultry
Capacity
Pop.
Cattle Capaci#y Pop.
Wean to FinishI
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
ILayer
I
❑ NE
Dairy Cow
W to Feeder
Non -La er
I
[:]Yes
Dairy Calf
eeder to Finish
/ ,S
3 32-
[:]Yes
`
°
Dairy Heifer
Farrow to Wean
❑ Yes
0 No
❑ NA
Design
Current
Dry Cow
Farrow to Feeder
D . P..ou!
Ca aci
Pio
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C!FNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
Ca -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214/2014 Continued

Facility Number: jDate of Inspection:
/ S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E[ 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
l
Identifier: .� o)Ld ,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 �� � 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?
[:]Yes
KL No
❑ NA
❑ NE
S. 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
Utes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
C!FNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): fM "L QvtdS��-J
13. Soil Type(s): / Nk 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
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 � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes Eg-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 t@ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: - / Date of Inspection: - i
�24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes O 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes [a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Fg 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 ® No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[:]Yes ®-No
[::]Yes ® No
❑ Yes 5 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
CComments
(refer to question ft Explain any YES..answers and/or ,�
any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
�; / �x z�,"o� r� F LoSfi /�nusC 1 S CdvS�ro" atcc'*5 0----
r
— -r"% r 7 r f -'L$ 71
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

v
" ivi'sion of Water Quality �—%fes
Facility Number - /Gwo1IVISIOn of Soi! and Water Conservation
Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 91Kooutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -1 Arrival Time: Departure Time: ', County:er— Region:
p
Farm Name:- �Yf�dQ,I�Q _ �a/tt1. Owner Email:
Owner Name: �! �� yTyn d r /� Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 n ,- Title: 62 U'n Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
i
Discharges and Stream Impact
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 gg 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)
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
i l
Des urr nt` Designs C r� nt
Desiga Current
❑ Yes
Swine
t 5M,
Capacity P
Wet Poultry
Capacity Pi
Cattle Capacity Pop.
❑ NA
❑ NE
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
j Non, La er
Dai Calf
Feeder to F Wish
3 D
�T�
Dai Heifer
Farrow to Wean
Design Curr nt
Dry Cow
Farrow to Feeder
Farrow to Finish
GiltsNon-La
D . l;oultry
Layers
ers
Ca aci I?o .
Non -Dairy
Beef Stocker
Beef Feeder
Boars
''* 4
Pullets
Turke s
Beef Brood Cow
-
.
OtMEMO
Turkey Poults
Other
Other
Discharges and Stream Impact
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 gg 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)
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
[] No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes
[4 No
❑ NA
❑ NE
Page I of 3 214/2011 Continued

Facili Number: - Date of Inspection: S=/L-
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in): r19 1 per, j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EkNo ❑ 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
[N No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[%No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (dirt6e04—
13. Soil Type(s): W T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [H No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—]Yes ® No ❑ NA ❑ NE
[:]Yes [Q No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes KNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
�. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No 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
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?
❑ Yes
[a No
❑ NA
❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other cottaments''
Use drawings of facility to better explain situations (use additional pages as necessary). _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

firms U�T '31a?l 13
Type of Visit: WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: G Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency - 0 Other 0 Denied Access
Date of Visit: l LizJ Arrival Time: Departure Time: , County: SOMY)S&)� Region: FPO
Farm Name: Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address: hq3L_US flb qa i
Facility Contact: bi 1)%f
Title: 0 W11 P4 Phone:
I
Onsite Representative: ,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: pl!9°lam
Certification Number: a atl
Certification Number:
Longitude:
Design Cu went
Desi n C .:.
g current
Design Gtrrrent
z
"R ' o
Swine aCa ac P
a:: P h P'
We# Poult .
ry
Ca�ac� Po
M p z, .. P
Cattle Ca aci Po
p ty P•
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P,oult .
Ca aei P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
"
Turkeys
Other
Turkey Poults
Other
Other
Dischar2es and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ®'No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ 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)
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 ❑ No
❑ Yes E] No
[]Yes 52 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
Page I of 3 214/2011 Continued

)Facility umber: Op2L - J& Date of Inspection: 3
RNo
❑ NA
❑ Yes
t'No
Waste Collection & Treatment
❑ Yes
r5;Tfo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CR 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
❑ NE
Identifier:
❑ 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?
Spillway?:
No
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Designed Freeboard (in):
❑ No
Cg NA
❑ NE
Observed Frecboard (in): 31 a p
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
r2"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
T Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
R] 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
Wo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Callo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CR No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p 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
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
❑ Yes No ❑ NA
❑ Yes No ❑ NA
❑ Yes
RNo
❑ NA
❑ Yes
t'No
❑ NA
❑ Yes
r5;Tfo
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?p`Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21 . Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey.
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
Cg NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Fatili Number: a -
Date of Inspection: 3
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 ❑ 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 follgw-up visit by the same agency?
[R'No ❑ NA ❑ NE
P No ❑ NA ❑ NE
❑ Yes
C' No
❑ NA
❑ NE
❑ Yes
❑ No
&] NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes " No [:]NA E] NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes NJ No ❑ NA ❑ NE
[]Yes
2] No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
15 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations:.or any other�cominents
Use drawings of facility to better explain situations (use additional pages as necessary).
1Q) PlfOle, rc°st curfait cwvlfic+ o'C_Co"9'9J'/ aS Yeas C�01Pd- last yeas,
R(0) Forme iAh6 %4,P fPfm n 6 )ist 0IC,
Pqe w'k for� i — l D 1 C add i IW aV
I) Crof / IFS YJ� jWl,n Lef+d"Iji 1-r6 efio1! `l Y
s}Sri l+ewls are_ joc& , ROW( e1i fbyefor ecW&, i'F C0f)'1R10(-Sv,-vfys arer�i�
io Poll,
YVd) moh'7 4`&M 4yia� sera -ds',
Add $M a I hok fiof �,� nao fo w�°csocC 1a sly
Cmc MOW Io df 11 IJO( OldOIC
yTy 1
Reviewer/Inspector Name: T6 a) Sc h n el R/—' Phone: TQ—q33-3333106r)
Reviewer/Inspector Signature: Date:�IX� r'a a of 3
Page 3 of 3 21412011

U
'N
Ty
Fac.:.i
,., '* amv Date; .
N
Permit OIC NPDES (Rain breaker .-..�PLAf Annual Cert :.Daily 'f:Pipe
FB Drops
r l y �4��
La oon. am _;Sp4
5
Desi dnTr ' and !f asci eeordecf in
CE M, Ifil
Observed..'- 4-1+7 1-11-1i,P$ 11
Verity P ONN
�!M
Sludg6"-SOY .41
Sludge ji
-DeLft — 19 1:4 1
Oft
Liquid Trt.-.Zone
Rati6-SlUd-'d',, TAM t(n-e 6t U01 U ib 6: P. Or. -4 5
DatebUVbf lance/ 77777
Date Iasi WO
won- n -TA M To7- MOW M
Fn M.
MEMMEMS'
CE M, Ifil
Verity P ONN
�!M
B .
11075
Date last WUF
i1 Ir ii :I
1 %
Test 9
Soil T 1:: Crop Yield Transfer'Sheets
s: Z--7
pH Fi6ldli...1. Wettable Acres: RAIN GAUGE
Lime Needed;'! '©: r �`' I ` WUP Dead box or incinerator
Lime Applied 0 it Weekly Freeboard Mortality Records
CU -1
1 in Inspections i Check Lists
S
Water
Need 5 .120 min Insp. Storm
S iji -11! - .,Weather Codes
Need' 6 ;Tlil: . W 1:� I I
I 11,27P M M FM M- 9, pM, '
=40 01
mmul, n*�w
�MHNMMMi
Mm I N
1C.- E M V— MR
CE M, Ifil
Verity P ONN
�!M
B .
I L9 v MR.,
Date last WUF
WE J1
10-MIMAW Towm==
Date Iasi WO
Lagoon #
App.: Hardil�il e
Top Dike
Stop Pump
Start Pump
2 I1'
(:B - 6RMe - V1 16 131
L1, ql6-10130
�wk 50 LW We:
C
Verity P ONN
�!M
B .
E r1q,affiliations
Date last WUF
'FRO or Farm Records
Date Iasi WO
Lagoon #
App.: Hardil�il e
Top Dike
Stop Pump
Start Pump
2 I1'
Conversion 300.
!b aq: Zn -I 3000= 213 Val:
PH 315 0.7 (Ef- D?Y
IV,
(:B - 6RMe - V1 16 131
L1, ql6-10130
�wk 50 LW We:
C

Ofd) JV) Srivllk
DiviUon of Water Anality
Facility Nuntlaer - [til `� Division of Soil and Water Conservation
O Other Agency
Type of Visit: iSkCompliance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: (SRoutine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: ffo= Arrival Time: IOSSOT Departure Time: I In; 5- County:Region:
Farm Name: ( •Tu ndd/ I Pt) ,1!it Owner Email:
Nil,Owner Name: 1 I l7 Tr n gt l Phone:
Mailing Address:
Physical Address: Ly'N Uj PH 411 1/ Cifil ,
Facility Contact: W1} % Tv I I! Title: N4 ll Phone:
Onsite Representative: Integrator: r?1 fQ
Certified Operator:i��y �rna�gfl Certification Number: aa�3 r 6411
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desig
Current Design
Current
Design C•nrrent
n `Cap city
Pop. Wet4Pouttry
CEty
Pop -
Cattle Capacity Pop.
M No
❑ NA
❑ NE
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder )
Non -La er
I I
Dairy Calf
Feeder to Finish
""
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,u_ult ;
-Ca aci
P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
OthNMI=
Turkey Poults
Other
10thcr
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[:]Yes
❑No
❑ NA
❑ NE
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?
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
Page 1 of 3 214/2011 Continued

Facili Number: - Date of Inspection:
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A� a` Ad_
Spillway?: _ 19 19
Designed Freeboard (in): - 37
Observed Freeboard (in): �d-
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.)
Z, f
❑ NE
❑ Yes
[3 No
6. Are there structures on-site which are not properly addressed and/or managed through a
10 Yes
:R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
IRNo
[:]NA
E]NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2g 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 E] Application Outside of Approved Area
ccr
12. Crop Type(s): t`.p(hq'U I berm. Ja (yglm e '_ -Shall Cy F), _
13. Soil Type(s): knAyva_
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes 5allo ❑ 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
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 �RNo ❑ NA ❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
❑ Yes
ta No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
® o
❑ NA
❑ NE
❑Other:
21 . Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ER"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ®'NA ❑ NE
Page 2 of 3 2/4/2011 Continued

• Facili ' Number: ?L- - 16 q I I Date of Inspection: 5-1971-3 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Rev i ewerA nspector fail to discuss review/inspection with an on-site representative`?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C? No
❑ NA
❑ NE
❑ Yes
❑ No
U NA
0 NE
[:]Yes
t'No
❑ NA
❑ NE
[—]Yes tWNo ❑ NA ❑ NE
❑ Yes 5J -No ❑ NA ❑ NE
❑ Yes
123No
0 NA
❑ NE
❑ Yes
gNo
❑ NA
r] NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
t!3,No
❑ NA
❑ NE
C (refer to 9 ) P. Y Y Y �
Use drawings of facility to better explain situations (use additional ? pages astnecessarv), mendations or:aa other cornmen
@y, W, l n 4 io C -d U jya1P_ +hfs pvT .
7, ���Vje iN k oh � 'e s g Opt )a m bol1U r� I` doej,no s �o, vc1r.
T-erta Nue Vv05-'W SAvt d 0An Q ho.t Q hiPP�'1 o 0 , S`1`i �� l� C I Mi �p
r, i l l b � t �(Al I ;� 0
fora ) S hell mrhloihek 4 re(adi my nA Ar't 60t wee rc,'to, .rf l ,
L -+--co=rm -eor- D I c q -"UP,
C) 01 mcIa�h�c.
i�ct,v1
n Of
i
ahoy �of�lpdvi co�C .�.
Reviewer/Inspector Name: O
n n n
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ft -q33-3-10
Date: Mo
/4/2011
e

Facility No. ';3-1 Farm Name Ili Date j)�,
Permit COC OTC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
z6E IL?►- R pv 51yr f �
Lagoon Name, S forspillway 1 2,6 3 old 4 trl yb 1 6 7
Design Freeboard / Last Recorded in 38 3
Observed freeboard a
Sludge Survey Date I
Sludge Depth ftS,
Liquid Trt. Zone ft ,p L4,
Ratio Sludge to Treatment Volume if? 0.45
Date out of compliance/ POA?
1k
- �Qrntir.������v■�■
Design Flow (gpm)
Actual Flow
Wl- V" old M co,by 0- XT't u3i-h ���
Soil st at Ii,11,10, P�41 S Crop Yield Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed WUP ✓ Nei- �11) Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records /-
Cu -I ✓ Zn -I 1 in Inspections ✓ Check Lists
Needs S (S-1<25) 120 min Insp. v Storm Water
Needs P Weather Codes
N (lb/1000
_ R �1d]M'a
Ruffield.,
5..E - 1r (Xg 6,6v
Verify PHONE NUMBERS and affiliations
Glii1 p d- yl7
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike j
Stop Pump 61rn�d r'
Start Pump I
or. Tyr�t�Ql�
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac !
lljWr, PAiCS 0, •5c a, ,,�otlaS�

�3NJ ass ala LilI
.A 1 r
Division of Wate Quality
Facility Numbeivision of Soil and Water Conservation
®Other Agency
Type of visit: wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: i$ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: ® County: �g
Farm Name:D Mail n. , Owner Email:
f
Owner Name: 0 t1 Phone:
Mailing Address:
Physical Address: k_3 f Us
1
Facility Contact: N) 16
t Title: luL Phone:
Onsite Representative:b6 Integrator: Pfeltog e—
Certified Operator: Certification Ntimber:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region: FRO
Discharees and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
n No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
P"No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

N

VVacility Number: S 5, -I Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes
No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �A C'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): U Y
5. Are there any immediate threats to the integrity of any �offtthe structures observed? ❑ Yes [allo ❑ 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 t!g-No
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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? 21 Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes S No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
21. Does record keeping need improvement? If yes, check the appropriate box below.
9. Does any part of the waste management system other than the waste structures require ❑ Yes CRNo
❑ NA
❑ NE
maintenance or improvement?
❑ Waste Transfers
❑ Weather Code
Waste Application
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�;No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
❑ No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JR No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
2/4/2011 Continued
❑ 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 [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No [] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes f5a-No ❑ NA ❑ NE
1 S. Is there a lack of properly operating waste application equipment? ❑ Yes IR No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fj�rNo
❑ 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
5TNo
❑ 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
RNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
f5?NA ❑ NE
Page 2 of 3
2/4/2011 Continued

Ifacili .Number: T -X IDate of Inspection: -71 f j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1�? No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
RNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
W No
NA
❑ NE
Other Issues
❑ Yes
�gNo
❑ NA
❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
JR No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
[:]Yes
0 No
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[BNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
5] -No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
§jrNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�gNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
El No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
0 No
❑ NA
❑ NE
Use drawings of facility
Exty to better explain situations.(use additional pages as necessary): - rents.
Comments refer to Iain an YES answers and/or an additional recommendations or an other cnmtu
Good- pz�vesf th Che he sf t�d'\ 1 h, �Y f� D fl byre Ma he;
pje4rna• J' spCroF.
a
I. Re w— 1)e'v C'rO f cycle Q"
as, SftdyelitedWe--o ilwaa-&esy�.
FOirn U sect r GYM i� A600eXct ar nod a IVLle,
Reviewer/Inspector Name:zlnao Lc�7ae)"15r- Phone: qlQ—
Reviewer/Inspector Signature: %Date:
Page 3 of 3 V U oil

Type of Visit ('Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit (WRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® ArrivalJ Time: �, SdJ4 Departure Time: � County: l Region: F-RO
Farm Name: Dag Tyndall FQ Owner Email:
Owner Name: _Jyd11, TU rida Phone:
Mailing Address:
Physical Address:
Facility Contact: rt Title: wn'l' Phone No•
�lll
Onsite Representative: lundall Integrator: f6ja P
Certified Operator: TQ i _ Operator Certification Number: �s3t if
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
=I = Longitude: =0 =, = "
=Design Current
❑ Yes
Design Current Design Current
---C.apacity Population
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ NA
❑ NE
❑Dai Calf
eeder to Finish
❑ No
Dairy Heifer
❑ Farrow to Wean
5
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Non -Dairy
❑ Farrow to Finish
❑ NA
❑ La ers
❑ Beef Stocker
❑ Gilts
t'No
❑Non-ers
10 Beef Feeder
❑ Boars❑
❑ Yes
ts
El Pullets
Beef Brood CoyA
_ �--�;
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
Number of Structures:
❑ Other
12/28/04
r s
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
RNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
t'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
DjNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

,. Facility Number. a — Date of Inspection
Soil type(s) Y04' Nom
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [5�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: Old -
Spillway?:
Do the receiving crops differ from those designated in the CAWMP?
Designed Freeboard (in): a3 Q3 Ri
U No
Observed Freeboard (in): Lf 19
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 1�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
tgNo
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes 5rqo ❑ NA ❑ NE
through a waste management or closure plan?
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
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?
[9Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U 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 o No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IR 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) Y04' Nom
AL
T
Reviewer/Inspector Name AVSC Phone: cl It) -y :3-3
Reviewer/Inspector Signature: -A;" Date: _q);)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
tgNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
EC No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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):
AL
T
Reviewer/Inspector Name AVSC Phone: cl It) -y :3-3
Reviewer/Inspector Signature: -A;" Date: _q);)
V 12128/04 Continued

Facility Number: — I(p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �;] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [--]Yes CRNo []NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design E] Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 1 'Yes �NNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 9Waste 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?
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
❑ No
Q NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
[2�No
❑ NA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
❑ Yes K;No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA Cl NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes CffNo ❑ NA ❑ NE
❑ Yes
IRNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawings: „
.00- ."w
3 y. S'jb51"Fare Ora1j - Wone Knowno
bgrp_ sro-s On I ajar,' m"ch redi.4Ih sh-e st, I I a -few smlll Ch ef,
Tj�,d e s I c ye- cI's ja0d ,
Pica e- w44�h at aroa.1dt 4!d layaon o
e,d of Fay fi
A be_ h' II �q d a� AN) � Scmc
a I, Avg 0AA fIj . q
sorb late- GhJ_ W, �t
a s s✓ -l- j A f
� r
�x��ns�ol noty�t-.s��d
s h ye
Page 3 of 3
12/28/04

Facility No$Farm Name -Ni 11v Twida11 Date q1)
Permit ✓ COC ✓ O CI NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Desi n freeboard
Observed freeboard in �k =
Sludge Survey Date 3 5
Sludge Depth ft f,
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Soil Test Date 9I1 a
Wettable Acres
Design
pH Fields-
WUP
Dead box or incinerator
Design W• .
-----�-�
Actual Width
Lime Applied
Soil Test Date 9I1 a
Wettable Acres
RAIN GAUGE
pH Fields-
WUP
Dead box or incinerator
�}'
Lime Needed` {i
Weekly Freeboard
Mortality Records -�
Lime Applied
1 in Inspections
Cu -I ✓Ln -I ✓
120 min Insp. ✓
Needs P X5-
Weather Codes
Crop Yield . q
Transfer Sheets -7
Nalmn M.,
Gal)
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
Q- -'\- *3 H41- 4�s
t- 6 o7fU
111I` 'mvG{
Srn small (2,0o'N',s r- M
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
App. Hardware

B Ik1 Rlal
Type of Visit OkCompliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit aRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 other ❑ Denied Access
Date of Visit: Arrival Time: 1 � Departure Time: County: St%'i Region:
Farm Name: V T Owner Email:
r /
Owner Name: T� n a 1 Phone:
Mailing Address:
Physical Address: t�
Facility Contact: �L�81�U _ Title: Phone No:
t
Onsite Representative: da Integrator: QA
Certified Operator:y ndaOperator Certification Number: 2! as
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =f ❑ " Longitude: =0=6
°a6 ❑
Design Current Design Current Desigu Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
1. Is any discharge observed from any part of the operation?
❑ Wean to Feeder
ID Non -Layer I
El Dairy Calf
❑ NE
® Feeder to Finish 151
❑ Farrow to Wean
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Beef Stocker
ElBeef Feeder
❑ Yes
Gilts
Boars
PF1Turke
El Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
s
❑ Turkey Poults
Other
of Structures:
❑ Other
❑ Other INumber
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Flo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[INA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
03No
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J'No
❑ NA
❑ NF
other than from a discharge?
12/28/04
Continued
-1

12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CkVo
` Facility Number: — Date of Inspection
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
tkNo
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier: A 13
T— -
Structure 5 Structure 6
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
'�jNo
❑ NA
Observed Freeboard (itt):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ISJNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
.Yes
❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health -or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
t No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
19' -No ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
W'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CkVo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tkNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
Q7No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'�jNo
❑ 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):
A,
Reviewer/Inspector Name sc I rA Phone: %0-4 3 OQX33 3
Reviewer/Inspector Signature: Date:
V 12/28/04" Continued

•� Facility Number: — Date of Inspection _ DToq
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CWNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes IQ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. '&Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes %No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No PNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J;�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
S�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
,E5 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CqNA
❑ 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
Wo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
f kNo
❑ 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
(FNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1?fNo
❑ NA
❑ NE
Additionaf�Ca_mE_n its aadlor Drawings:
AL
�C��e�s' abatdalt 1 a�oo,� mahirhi l ► La3t-vier1 q8 `#,
Hz
12/28104

Facility No. i�� Farm Name
Permit COC
Pop.Type Desi n Current
Tnal,!4
Date
OIC_ NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
--- ---
Spillway
Design freeboard ---
observed freeboard
Sludge Survey Date
r5 7
of ; F:; P.W-4 M. 4-4
r -
ActualDesign Widt
Soif Test Date VF6 641�
pH Fields
Lime Needed
Lime Applied
Cu Zn
Needs P
Crop Yield
Wettable Acres b,./_
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspctions
7/k/r�. r
-7/Ari —�
waste Ana!ysis Date
60 Iray
.i Day Ord
FA
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
MirkI (� ul---,
PulliField
Soil
Crop
RYE PAN
Window Max Rate Max Amt
r5 7
M -930
'
u
so 3
>ti
S
100
-D
4A-
NoA
IS6Mel
S- F
lop -
Verify PHONE NUMBE�S and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App, Hardware

ff
Type of Visit R Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:{{ � Arrival Time: Departure Time: ..7� County: O- S Region: ,. =po
Farm Name: i]nda U E�/� Owner Email:
Owner Name: hu Phone:
Mailing Address: iaTl f'' o mim
Physical Address: I
Facility Contact: n A 116 TYriI j� Title: Phone No:5(0+-491)0
Onsite Representative: Integrator:
Certified Operator: Binv iEinda/1 Operator Certification Number: o
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = =, = Longitude: = e =I = "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design Carrent
Design C+urrent
❑ NE
Swine Capacity Population
WetxPoaltryCapacity Population"
Cattle Capacity Popufatlon
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ No
❑ NA
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ No
Feeder to Finish i
- a' !;'
..> l
Dai Heifer
❑ Farrow to Wean
ak
Dry Poul[ry_:=
❑ Dry Cow
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Farrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ La erss
❑Non -La ers
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ Boars
-.._ . -
❑ Pullets
❑ Turkeys
❑ Beef Brood Cowl I
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Other
❑Other
❑ Turkey Poults
❑ Other
Number of Structures:
other than from a discharge'?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IR No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12/28/04
Continued

169
Facility Number: "a- — Date of Inspection
Soil type(s) JJ o A )S Wa LS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure Structure 4
Structure
5 Structure 6
Identifier: A AlY►
❑ NA
❑ NE
Spillway?:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
tR No
Designed Freeboard (in):
❑ NE
17.
Observed Freeboard (in): c3 3(p p7�
❑ Yes
allo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15?No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
PNo
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo ❑ 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?
13Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
5jNo [INA ❑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
R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
W 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) Cob -fa I ''ff M ado i H'q_ P) DS
13.
Cvmments,(refe� tvgesdiin #j in anyYE5�a(�n�swers
Soil type(s) JJ o A )S Wa LS
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'CRNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
I 'No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
tR No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
dAti
ther comments.
`[lse draw of facttr 'to better ex lain srtuatrans. use addtttvaal� es as necessa
:,.:- r!5r, a�hg.i�:.::., �..r-r:•sr., $'4.n�'A'��r•4:.�:.:.;d�-s.a�, �- t1�i
L
Reviewertinspector Name 110AV Atba7IE& Phone:
Reviewer/Inspector Signature: Date: a A?
Page 2 of 3 U Il12v 4 Continued

Facility Number -00a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes $2 No ❑ NA EINE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IQ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �d No ❑ NA ❑ NE
23. - If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N No 4 NX ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BNo
(#NA
EINE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�j No
V[NA
EINE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
IRNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
m� ,
ay,1� i f l nP-ek CA t limbi kf Pnd o07ecr
as� hal I n�� sr�d� ye 5vr✓e kfae ad OPYPW.
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
[RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
['No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
UNo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
1ANo
❑ NA
❑ NE
_.'... . by w -• ,_ 2`M_ & .h-'� h �'.'..' �:uxN
Additional CammentsPaad/or�Drawrn
(v. A a la�A bet' mm4bd vietekej s"F&mKi�,&alh je, Ins ;d -e- hmo yvill)
a
S to Piy ands - orsedd
Onter-Epi^ on backsi�e get� A � vUI i e l^�f��t �fih►�r� I� , Pl�teadd l Ii)ne I
m� ,
ay,1� i f l nP-ek CA t limbi kf Pnd o07ecr
as� hal I n�� sr�d� ye 5vr✓e kfae ad OPYPW.
H,,
Page 3 of 3 12/28104

U
Facility No.'FQ-{ 'f Farm Name
Permit COC OIC
Po . T e Design Current
F$ Drops
Date _ � 13 ^r !-x
NPDES (Rainbreaker
PLAT Annual Cert )
O 1 -,'1 ff Y\w ri in F lM1 rDw: A h- i n -!IM 1,411
Calibration
——�---
Design --�—�
Soil Test Date I i 15�" !
Crop Yield `�
1 in Inspections
• . - - . w3 E�Z�rzLwwm
Min
120 min Inspections ✓
Weather Codes
Cu � / Zn Rain Gauge ✓
Needs P _1UQ— Weekly Freeboar��
11no..t�R :in! AA
O 1 -,'1 ff Y\w ri in F lM1 rDw: A h- i n -!IM 1,411
Calibration
——�---
Design --�—�
Soil Test Date I i 15�" !
Crop Yield `�
1 in Inspections
pH Fields le
Lime Needed
Wettable Acres ��
WUP �_
120 min Inspections ✓
Weather Codes
Cu � / Zn Rain Gauge ✓
Needs P _1UQ— Weekly Freeboar��
11no..t�R :in! AA
Transfer Sheets
Pad-
.V._
.i ..
JJ Amt (113/1-000 jj WLW
Pull/Field Soil crop Pan Window
3Os
! I if -- l v ••1 q I
No), cl� 1�w Be* Ilk

I'%
NDS u I D O -A t._
C
079
VDivision of Water Quality
Facility Number �� Q Division of Soil and Water Conservation .
Q Other Agency
Type of Visit )5 -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 ❑ Denied Access
Date of Visit: 4 U Arrival Time: Departure Time:L5 ��J County: Region: *rko_
Farm Name: _ (Z�T'An�t _ Owner Email:
Owner Name: ZT �, Phone:
Mailing Address:
Physical Address: `
Facility Contact: l Title: Phone No:
Onsite Representative: 6t 1 Integrator: �f
>*-tified Operator: Operator Certification Number:
!! Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =' a « Longitude: = ° ='
0 «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T.__ ❑ La er
_ ^� _ I ❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & 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 Heifei
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 'No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
JONA
❑ NE
❑ Yes
_%No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04
Continued

Fecility4umber: a —10 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PP No ❑ NA EINE
Structure l Stru tune 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: a *—Su i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes JZNo ❑ 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 Q No ❑ NA 4NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA
(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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
mai ntenance/improvement?
❑ Yes ❑ No ❑ NA �,NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA t 'NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
tONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[kNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA 9 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
1)-aNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
9NE
Comments (refer to question #): Explain any YE&answers and/or any recommendations or any other comments.
Use drawings of facWty to better explain situations: (less additional pages as necessary):
AL
Reviewer/inspector Name T� ��� phone: j
Reviewer/Inspector Signature: Date: 1
Page 2 of 3 12/28/04 ContinuNiJ

Facility Number. Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ,Eq NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA IkNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
[INA
ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
.fNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
QNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
NENE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
I RNE
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
❑ No
❑ NA
8 lE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
N 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
f9No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
kNo
❑ NA
❑ NE
Additional Comments and/or Drawings.
srt�m
U ron
�hCti`r Q, nm 004 IA o_ r,C � �drlf h iepy� S
�i �+
�j r f � Zig b, W
T.� , Sl., h , �, `� i A � S Cl 1c� U [, S `t (3c r �t � �V ►mac �
✓�1e f�v� pec USt��} �� A VsFor+ as 44 1 Lgar
&�l l `-(o ave (cy G.t,..� sub r~,.. -f o ( m (�-nuc�Q
�I b I l 2�
0. n o �4 f 0.`t �f --r o. , n , „-� ti c• '� U 1 r
Page 3 of 3 12/28/04

f�
y'
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency 6 i
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit vl&outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: dl Arrival Time: 4E= Departure Time: Coun Region:
Farm Name: TLA L I Owner Email:
Owner Name: 1 n Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 11
Certified Operator:
Back-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
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =]o E=]' [—] Longitude: =° =. = W
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
{ 1 10 Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: j
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 INo ❑ NA ❑ NE
❑ Yes
❑ No
XNA
ElNE
❑ Yes
ElNo
�A
El NE
❑ Yes
❑ No
-&NA
❑ NE
❑ Yes
bo
❑ NA
❑ NE
❑ Yes &bNo ❑ NA ❑ NE
12/28/04 Continued

v
Facilitv number: t�-
Date of Inspection ip U
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
Identifier: I&
Spillway?:
Designed Freeboard (in): Iq 19
Observed Freeboard (in): '7 y
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 h10 ❑ NA ❑ NE
❑ Yes ❑ No D3:A}A EINE
Structure 5 Structure 6
❑ Yes AbJo ❑ NA ❑ NE
❑ Yes _kNo ❑ NA ❑ NE
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? -k Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes TNo ❑ 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
El Yes WNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '%No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) w0. ; Nrp -rA v
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IffNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
10 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17�bjo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ YesNo
lNo
❑ NA
❑ NE
1$.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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):
q1 N" - -'n pso, l d re-sted/ m kIcA akea.o c lC
Latwn5_
Reviewer/Inspector Name Phone: 3
Reviewer/Inspector Signature: Date: O I a tD
12/28/04 Continued

Facility Number:K.) — Date of Inspection l 1_2k[_Al
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [NVo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes i�&No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�Z(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes )
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�'TNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P;�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
17RNo❑
NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
*W 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
[ANo
❑ 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
A] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: �x ,M _
C
2.r at s C_rtrtr. ScArr;4r 7ecA►1o/03z ST, -k, 1c,rQ4. T�-
- 91"X -,-,k &� -a ty� -
—S( "
S(" r 4e--l�✓��A�rn¢e� Vb i s m e 1 Sr' O l,�hear
e AS ' (0-31
Page 3 of 3 12/28/04

Facility No. Time In ©`i Time Out Date b
Farm Name U Y Integrator 1i_i?/J
Owner Site Rep
Operator No. a 3
Back-up No.
COC V Circle: QGenera or NPDES
3
Design Current Desl n Current
Wean Feed Farrow — Feed
Wean — Finish Farrow — Finish
--re—ed , Finis Gilts I Boars
ft n Others
FREEBOARD: .qui Des'
Sludge
7
Siuuyc �tcy
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop _
Weather Codes
PLAT
Daily Rainfall
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Observed
Calibraticv..!GPM ✓ 1 r✓
Waste Transfers
Rain Breaker
Wettable Acres
1 -in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
a
bc) 0C
Mn H 34
l7

V.
Type of Visit AEC ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit @B autine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:'1Q'� Arrival Time: �Djeeparture Time: : �� � County: .Sa"�' Region: o
Farm Name: � Q�-- TSi�2arOwner Email:
Owner Name: j Phone:
Mailing Address: G/3 I AJ i s -loq 1 tlY
Physical Address: ,,-a�.,, 11 /
Facility Contact: dJ I y �Si�Of4 _Title:
Onsite Representative: f &&&a!
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:g 4 +C—
Operator Certification Number: C921S3y--
Back-up Certification Number:
Latitude: 0c ❑' =" Longitude: 0°=I = di
Design Current
DesiMcuhrenDCurrent
[3 No
Swine C*apulation
Wetpuation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
iry Calf
❑ NA
Feeder to Finish % jas
-
❑ Dairy Heifer
RNo
❑ Farrow to Wean
Dry Poultry
El D Cow
❑ Farrow to Feeder
❑ Non -Dairy
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ NE
Gilts
❑ Yes
Beef Feeder
❑ NA
PIE]Boars
Pullets
❑ Beef Brood Co
Eallo
-,z
❑ Turkeys
other than from a discharge?
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Page I of 3
12/28/04
Continued
Discharges & Stream Imjacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[jNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
RNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
EkNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2tNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Eallo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued
h.

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [YNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A a '%P/_4W
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?F-1[—INA NE
(ie/ large trees, severe erosion, seepage, etc.) ❑ Yes Qq No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 5�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [NNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
LL ❑ Evidence of Wind Drift ❑ AApplication Outside of Area
12. Crop types) M a [T�1 Q—<"Q Z ,, 1�' m�tn rcT +-� 011 e —
13. Soil type(s) W A 13 r/ At o> - _
-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PqNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C! No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
`Comments (refer to question #} Explain any YES answers and/or any recommendations or any `other comments r
Use drawings of facility. W better ez -" srtuaboas, (use additional pages as necessary): :
pv-c 0 ou &r'a ; -L 6 i -. F�'D
b
jai � /%%C,z�'�� Y`_' GZ%I 7 � �.S c� /TctlJr �!1 FS �f1 i�Gf: rd•
Reviewer/Inspector Name I— Phone:
Reviewer/Inspector Signature: Date: C) O'Z-Do
Page 2 of 3 12/28/04 Continued

Facility Number: b Date of Inspection0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ 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
(� No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes RNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
H No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[N No
❑ NA
❑ NE
and report the mortality rates that were higher than non -nal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
K 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
DjNo
❑ 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
EMNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Pq No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28104
Page 3 of 3 12/28104

® Division of Water Quality
Factlity'Number Q Division of Soil and Water Conservation ✓� �7 a j
-- — Other Agency
m
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: -SA Region: tae,
t
Farm Name: _�_ �_�_- - ar vw _ Owner Email:
Owner Name: L? 1 A n Aet 11 Phone:
Flailing Address: _6 N � i No r �+IA -4. �LikL+7 _-- �_l_�.�+nom / C •7 $ 3a;9
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: . ��� _ l�/�L� — Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ` ❑" Longitude: =0=,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Nan -La et
Dry Poultry
❑ Lavers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl I
!Number of Structures:
K Did the discharge reach waters of the State'? (If ves, 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 D1A'Q)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes � No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[I No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 0a- y
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -
w A ,t3 0b�f.,�nr+
Spillway?: 4W S -/y3 .3J 7/ 1I/
p�
Designed Freeboard (in): / 9 is 7
AlrS
a zQ.7
Observed Freeboard (in): le
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [M No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes % No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Q Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes P 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 Q0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes [� No [INA El NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R 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) _ r 92UdAL
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes CA No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes L� No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [N No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 9 No ❑ NA ❑ NE
Comments (refer too question 9) Ezplarn�any YES.an a and/or any recomme�ndations.or any other comments.
-� :
Use drawings ofifaciility toobetter'eaplatn�situ�#ians. {nseaddihonalygagesaas necessary]:
7- rnpsa k10O�i�
lax f
94--t-
%4 Pv,)
6v.-4.
S46n.0,
cL." i M!
'cow. I rtaf 1� �ti C -f-U
Jar .
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Phone:
Date: rr /,.?3 jbS
12/28/04 Continued

I
.
Facility Number: IF — �{ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE.
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CE No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
. ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes]
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
Op No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[M No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 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
P 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
V1 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Aildthianal Goiaements'andlorDrawings o ,. ; ,�,�M�,l� �' �;::
ck r,dJ
Y
Gari Gj c -F-
12/28/04

Type of Visit ® Compliance Inspection O Operation Review O lagoon Evaluation 1
Reason for Visit ® Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date orvisit: Time: o? SS
Q Not Operational O Below Threshold
U1 Permitted 12 Certified j] Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: ......_. 1J.. g -------- N � � . F4 "'"' County:W. S soh ........ ---- .. F K0
Owner Name: _..__ --------- _. ��!��a � Phone No: �i 1 C 5-4 q - y i
Mailing Address: �....1. ! �. r±�• 5. ?� a . N ` �' 4---- ---- .�� ti? fes? � N� _ . —
Ma � -
Facility Contact: Title: -- --- ..._—_..-...._. .. Phone No:
Onsite Representative: .......
Certified Operator:_...........__� Operator Certification Number..
Location of Farm:
[4 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` u Longitude 0 ` "
Discharg 8 Stream lmpact4
1. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/rain?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:....._..�.- .............. ...----..... .. __- ..M_.................
^ M ^
Freeboard (inches): a O 3 oZ
12112103 Continued

Facility 1pmber: j j — / 6 Y
Date of Inspection S oY
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes j50 No
❑ Yes ® No
❑ Yes jgJ No
❑ Yes No
❑ Yes No
10. Are there any buffers that need maintenancelimprovement? ❑ Yes [ No
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper `and/or Zinc
1
12. Crop type C nQa+o ��r......�c IA c.* re-Le"Q 6 1A-:4 = C7pis_ �4C = 7- 1_X
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes W No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes IN No
c) This facility is pended for a wettable acre determination? ❑ Yes Q No
15. Does the receiving crop need improvement? W Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or Iagoon fail to discharge at/or below ❑ Yes 5 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [;.No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Va No
Air Quality representative immediately.
Comments {refer t° gnestion �) .,Explain any YFS answers and/or any i+ecommendat�oas or any atter cmm�eents. � � � dmx . ` �..
;Use drawrngs of fact'lrty,to better expiate situattaas. (nom add:honai pages as necessary) � � � F=eld Copy ❑ Final Notes �
r ^�
L
K
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: S%l8 /ay
12112/03 (2' -1,/ Continued

Facility blumber: 8a� -- 1(p Date of Inspection SI/PI a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I• If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
❑ Yes M No
❑ Yes [1; No
❑ Yes OJ No
❑ Yes Q No
❑ Yes M� No
❑ Yes (i.No
❑ Yes Q No
❑ Yes CtNo
❑ Yes JU No
Yes ❑ No
❑ Yes tD No
❑ Yes 53 No
❑ Yes P No
❑ Yes K] No
❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddttsortal Comtneats and/`Dtawtngs
�-�_ ���=�_�._�-.�:�.•.:::�..�_- �_;.��.�_��_x__�._ ��.�- =�_
!!1111
�
� f �, N � }� �' 1TJ
rl
CiIOC�n(l� ,i
a (�
C O 1vL C t 4 6 .n ,n. 9, S L 4 4C.
(' l U
C a. •T Q- 1 4-i o` r 'r -t �`\ s s j'0 r 4 "L ' V% cti h• C
-�� i7
yN m "'J% .. q
T
12/12103

Site Requires Immediate Attention: N0
Facility No. S2 - /t., y
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: SJ!) V8 1995
Time: [ 3 : O
Farm NameJOwner: L3 E S T 4 i s A4 t ; i H 1 y K c 11 . 13 e cky y,j da
Mailing Address: _ Rt 3 R o% 3 47- C 1 rive ni Ak! Z 3 3 2. T
County: SQnnpSonl
Integrator: taipea., ri_y rAv c Phone:_ "I/O) - '�9 Z -5-7 7 I' On Site Representative:' OJ§4 _ TY�vdu!% Phone: tWO) 56 0�- 44,3'70
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3i70 o"Im sh Number of Animals on Site:
DEM Certification Number: ACE
Latitude: 0Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: S Ft. 0 Inches
Was any seepage observed from the la n(s). Yes on(D Was any erosion observed? Yes ot(D
Is adequate land available for spray?Ye or No Is the cover crop adequate? Ye or No
Crop(s) being utilized: Bev-w,v.�_/ Gema*v
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?Yes or No
z
Additional Comments: e /O S Q3
DEM Certification Number: ACNEW
R;c-k4 ReveIs
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

f i
90=9 CAROLIIM DXPJMT!!MT OF , HHALTS A NATURAL RSSOUMM
DIVISION OF F.IMIRoMMAL MADULGMCMT
Fayetteville Regional Office
Animal Operation Compliance Inspection Forza
S .K __.. - d[!.w,..-•'n �, .-4. .M #. .iY.�r:*`..r Y`�r �c. ... azo :r M...�Y..r....`:...
:
NUHMM��y,�,.�..y
'+•x• M' Hix� ��} ��yw�'•/��p� ��/���¢ �j{f�p��nr�+..W+.cr
r>;�µ;-� >"F"". �u+�+iRTrN+i/i4i+N�i?i:inn!'�6gf
a -O� ;h fiL�iLii� :moi La+i.Sii1.J1.�i+` ..11{if'aoAfiR 6'
t 3 F
2�3Z X104- U
All questions answered negatively will be discussed in sufficient detail in
the -Comments section to enable the deemed Permittee to perform the appropriate
Corrections;
SECTION I
Animal Qration :Finish
Horses, cattle, wine poultry, or sheep
SECTION 11
t. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maiiitained
in this facility for a 12-manth period?
4. Does this facility have a C MT1YIED ApIM
WASTE IMMGElsENT
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
C. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
Y 9 H ! COUNTS

Almon III
kield sitean
1. 7o nnimal raLW BLstCV118d Or lagoon
construction within 100 ft, of a USGS
Nap Blue Line Stream?
Z. Is animal waste land applied or spray
irrigatvA vi *%4n 25 tt, of a U000 Map
Blue Line Stream?
3. floes this facility have adagvate acreage
on which to apply the waste?
4. Does the land applicatioW site have a
cover crop in accordance with the
MTXFICATION PLAN?
5_ Is animal waste discharged into graters of
the state by man-made ditch, flushing system,
or other similar manmade devices?
5. Does the animal waste management at this
farm adhere to Best Kanagement Practices
( BMP) of the approved CMMCATICW
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately ` )
8. Is the general condition of this CAF4 facility,
including management and operation,
satisfactory?
SECTION ly
Comments

7ft% 4
ISM
�."J.
4U. ..v...n 4w44. aQ IawWkmI IS nousu Tor me
�.
'
black mask across the face and the black
<
rings around the tail. The rest of the fur is
BILLY TYNDALL
'
a gray -brown.
The raccoon usually nests in a hollow tree,
Take 421 North fro
preferably near water. Raccoons eat a wide
Office 15 miles.
variety of foods, both plant and animal. They
Farm will be on le
feed on grain, fruits, insects, crayfish, frogs
before -.-you get to
and birds. The raccoon does not actually
You
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wash its foods, as many people believe.
Clinton Auto Parts.
However, they often play with their food in
=n
water if there a is water nearby.
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R=G:57RA :'IN FORM FOR. ANTMAL :- y
D O7 CPE?ATIONS
Departctentof Environment, Fzealth� andNatural Resources
Division of E.:viranmental Management
Water Quality Section
the animal waste management system for your feedlot operation
is
desi� ed to serve more r --"'.an cr
equal to !00 head
of cattle,
75
horses, 250 swine, 1,000 sheep, or 30,000 birds that
are served
by
a _icuid waste s,,stem, z. he:: th_s
Lc-rn, =must he fir' ed
out and mailed
dv ,Oecem:^eY 31; _993 Pu,sua= _ ::
i=A NC_zC 2H.02_7 (e)
o=de= to
be
deemed :emitted by DEM. ?lease
print ci ear'v.
arm Name:
Ma -=_^g Ab
Owner (s) Name : Z Z 1 lM..h��_ Zlrt,orba-1-1 .,
Manage= (s) Name:
Lessee Name:
Na _4T�q _<d _
7'-A= Lccaticn (Be as specific as cassi :lerr• road names, direction,
milepoS etc 4/a71 /V -''Rc,rn. F, 7- 'C e- 1 vrfr'IeS � qyy-1
Lac ;_ude /Long izude if )mown: (!.l S_1 15- / (.14 _ --
Desicn capacity of animal waste management system (Number and type
C ccnfinec anima: (s)) O ,�
Average anal popular -4 an on the farm (Number and type of animal (s)
-raised) : /
Year Production Began:/1757F ASCS Tract No.:
Type of waste Management System Used:�� 14
Acres Available for Land Application of Waste: ,•__fiz _
Owner (s) Signature (s) .
MV*A"AM
DATE,

❑ DSWC Animal Feedlot Operation Review
DWQ Animal. Feedlot Operation Site Inspection_-_-_
ILE
Routine O Complaint O Follow-up of D
Facility Number L
F61low-uo of DSWC review O Other
Date of Inspection Z7-9
Time of Inspection
Use 24 lir, time
Farm Status
Inter-� �� Total Time (in hours) Spent onRevietiv
.. _ ....... • - ••.— or Inspection (includes travel and processing)
Farm Name- �'� � � Ot Qe- � �gd'i'"L County: .� �-���
Owner `ame: ��i Phone
Mailing Address: q 3 us f n>ti { V C
Onsite Representative: L4 01C Integrator
Certified Operator.` d I Operator Certification Number: ��. J. 2.
Location of Farm:
Latitude 35 Q4 50 u Longitude �g • 22 ®u
D Not Operational Date Last Operated:
:y
pe of Operation and Design Capacity
Swine b1c]
Wean to Feeder Laver ❑ Datry
Feeder to Finish I0 Non haver I� ❑ Beef
Farrow to Weanx
Farrow to Feeder_M,
Farrow to Finish ❑ Other Type ofLivestock�r-"
Number of Lagoons f SoldingPond_ ❑ Subsurface Drains Present
Lag
oon Area _ IM Sp
Field Area
r x
r a Y r p�C ❑
General
1. Are there aav buffers that need maintenaneelimprovement? ❑ Yes No
2. Is anv discharge observed from any part of the operation? ❑ Yes No
a- If discharge is observed, was the conveyance than -made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify D WQ) ❑ 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 0 NO
Is there evidence of past discharge from any part of the operation? ❑ Yes NO
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes o
5. Dozy any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes
mainteaance/improve.:�eni?
Continued an back
4
Hwy 421 N (from Office -1 15 miles, farm on left before ettin to Clinton Autg BaCts.
10
Latitude 35 Q4 50 u Longitude �g • 22 ®u
D Not Operational Date Last Operated:
:y
pe of Operation and Design Capacity
Swine b1c]
Wean to Feeder Laver ❑ Datry
Feeder to Finish I0 Non haver I� ❑ Beef
Farrow to Weanx
Farrow to Feeder_M,
Farrow to Finish ❑ Other Type ofLivestock�r-"
Number of Lagoons f SoldingPond_ ❑ Subsurface Drains Present
Lag
oon Area _ IM Sp
Field Area
r x
r a Y r p�C ❑
General
1. Are there aav buffers that need maintenaneelimprovement? ❑ Yes No
2. Is anv discharge observed from any part of the operation? ❑ Yes No
a- If discharge is observed, was the conveyance than -made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify D WQ) ❑ 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 0 NO
Is there evidence of past discharge from any part of the operation? ❑ Yes NO
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes o
5. Dozy any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes
mainteaance/improve.:�eni?
Continued an back

5. is iaciiity not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after I/1197)?
8. Are there lagoons or storage ponds on site which aced to be properly closed?
Structures (Lagoons and/or- HolA!ajjondsl
9. Is structural freeboard less than adequate?
Freeboard (fr): Lagoon l Lagoon
2.5 1 2 • sr
❑ Yes ti'o
❑ Yes ,�,yNo
❑ Yes lEi lNo
❑ Yes Rto
Lagoon 3 Lagoon 4
10. Is seepage observed from any of the struc4aes? ❑ Yes gNo
11. Is erosion, or any other threats to the integrity of ..^.y of the sn-acnares obscrvcd? L.� Yes RNO
12. Do any of the structures need maintenancelunprovement? ❑ Yes q�No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adquate markers to identify start and stop pumping levels? Q Yes WINO
Waste SRR ication
14. Is there physical evidence of over application? ❑ Yes VNo
(If in excess of MP, or runo f enteric waters of thy State, notify DWQ)
IS. Crop type e e i'yt+A-t dQ ,/ �y*-4� // r
I6. Do the active crops differ with thos4esignated in the Animal Waste Management Plan? ❑ Yes No
17. Does the facility have a lack of adequate acreage for Iand application? ❑ Yes KI -40
I S. Does the cover crop need improvement? Q Yes XNo
19. Is there a lack of available irrigation equipment? ❑ Yes [�(No
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? Q Yes j& No
21. Does the facility fail to comply with the Animal Waste Management Plan in any way? ❑ Yes $�No
22. Does record keeping need improvement? ❑ Yes 196,40
23. Does facility require a follow-up visit by same agency? Q Yes*Io
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge? ❑ Yes No
Cammeats (refer to gtiesttan ) Fitplatn any Y�answetsand/ox city recamrtieridatzaas`otnny other corstateats
max„ >
:Use drawings oifacility to better explain.situationsusaddihanalpageseas nee ssa y�.y
Reviewer/Inspector'Name
Reviwer/Inspector Signature:
Date:
/Q-- Z.7-9 7
ce. Division of Water Qual(p.-'di'arer Qtruliiy Section. Facility Assessment Unit 11/14/96

Facility N=ber: $L _ i (o 4
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:? -ice
Time: _
S meral Infor ton:
Farm Name: ti rvcl CL
Owner Name: RI I t one NoSG �e - ow
Ozi Site Representative: L r - _ _ �Integtator: i�res -�••.s
Mailing Address: P,t 3 B a -K 3 q 7- S
NC Z R3ZS
Physical Addressli orad= _ S�ZI ^.,.P,4(, _ _ / �" n.:��s - r,•.., o.✓ /•
Latitude• II Lon 'lode• 1. _I
Operation Desgripti2n: (based on design characterisft)
Type of Swine No. arf Mimls. Type of FbaWy No. ofAnimalt Type of Cauls No. of Animah
a sem► O Lays o
0 Nay 0 Noe -Layer O Becf
a Feeder - 604 S 790
OmerTypr ofL hWxj a * Number of MimatLt:
Ntimbe r of Lagoons:_L�Cinclvde in the Draw1up and Observations the fiwboard of each Iagoeo)
Facility Immfi n:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the. lagoon?:
Is erosion observed?:
Is any discharge observed?
0 Man-owds C No: Man-amade
Cover 0
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?.-
(go
mprovement?:(list the traps which need irnp )
Crop type'a_r..�. %.. —Acreages:
�l o ek- Yes 0
Yes Cl
Yes 0
Yes 0
Setback Crftesfa - Is a dwelling located within 200 fed of waste application?
Is a well located within 100 feet of a+asteapplication? -: - - -
Is animal waste stockp0ed within 100 feet ofUSGS Blue Line Saum?
Is animal waste land applied or spray irrigated within 25 feu of Blue Lint Stream?
AOI — ]sauary 17JM
Yes 0
Yes ❑
No Cr'
No M-,
No Cr
No C3'_
No a'
No 9'
Yee 0Y. 0 '-,No Of
Yens 0 No Cr,
Yee O No a

maintenance
Does the facility maintenance need unproved? Yes ❑ No or'
Is there evidence of past discharge from any part of the operation? Yes -13. No or'
Does record keeping need improvement? Yes O No C3,
Did the facility fail to have a copy of the Animal Waste Management Pian on site? Yes a No O-'
Explain any Yes ans+ am-,
e= FaeffiryAssesmew Unit . .
prawinp or Observation;
Use Anacimmu (fNeeded
Zh�' _L'rp�Y. - •-.. •r*-i1r-►rrrtis.•rlw.no7+awa�1'�tlia�wri�+}-;i-:i.Fr•��ir.:•-c+s,
a�G,!• {� '.-! - - ;!!t=!:• :*i"�`:i mss'., _ •i0 �~'�: !i{'-9;� JY*�7-'�.'.�;"t" (' t1--- •..—
AOI -- Januaq 2744 - _ ,