310281_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual
II

Type of Visit p Compliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referrat 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: p /� Title:
Onsite Representative: I! ►r L Ga G r�l .
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = Longitude: [� o [� d [� «
Design Current
Desigu
Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity
Population
C+attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stacker
❑ Gilts Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
❑ Other I ❑ Other
Number of Structures: E]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (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?
[3Yes L'No ❑ NA ❑ NE
❑ Yes 4No
❑ NA ❑ NE
❑ Yes E]'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ,[_No
❑ Yes �No
❑ NA ❑ NE
❑ Yes )Y! No ❑ NA ❑ NE
Page l of 3
12128104 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Jallo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes „[?fNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�].No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes -E!fNo ❑ 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 J2-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ 2<o [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes . C7FNo ❑ 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 _,[�TNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (:. No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes g'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes _2 No ❑ NA ❑ NE
❑ Yes ,E:f No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ,12 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,ETNo ❑ 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 P-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesWNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 1 21412011 Continued

Facility Number: Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes EFNo ❑ 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
[frNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P] No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 4D 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
F1 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
E5No
❑ 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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
;"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�ZrNo
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
❑'No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.. I
Use drawings of facility to better explain situations (use additional pages as necessary).
61d'-Illr
I -Al y
Reviewer/Inspector Name: J( Co L 1,-- � "'JUI� Phone: q 167gb _17
Reviewer/Inspector Signature: I K, _ _ Date: 4 V'�L'
Page 3 of 3 21412011

type of Visit: Q'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f y�l�, Arrival Time: ; d Departure Time: County: PC,
Farm Name:��[C�n (llda/C,/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: IGL.t,& 46 5S rk, Integrator: /✓1 ��
Certified Operator:
Back-up Operator:
Location of Farm:
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D esign
D . P,oul Ca aci_ P,o
ILayers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impac#s
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 d No ❑ NA ❑ NF
❑ Yes
W1 No
❑ NA
❑ NE
❑ Yes
[7 No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
[—]Yes PfNo
[] NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storagq capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E�r_No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes d 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 dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P"o ❑ NA ❑ NE
maintenance or improvement?
Waste AnDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/ 21�4o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
ETNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fj No
0 NA
D NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes En�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 C'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes E!�'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: /9 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PTNo ❑ NA ❑ NE
25. Isathe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes UNo [] 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?
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.
36. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes C6No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes VI No ❑ NA ❑ NE
[:]Yes �j No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34, Does the facility require a follow-up visit by the same agency? ❑ Yes
W No
❑ NA
❑ NE
�No
❑NA
❑NE
�] No
❑ NA
❑ NE
No
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: Z 8 l
Page 3 of 3 4/ 044

Type of Visit: Q Compliance Inspection Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine OComplaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: — -�L Arrival Time: ao AMI Departure Time: County: 13y1 Region: W
Farm Name: i°1p�'=+�� `S (��M i�,�-Q�,� Owner Email:
Owner Name: Q$ . Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Curren#
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
Dairy Cow
Design C►urrent
Capacity Pop.
Wean to Feeder
Non -La er
I EJ
Dairy Calf
Dairy Heifer
DEX Cow
Non -Dairy
Feeder to Finish
Design Curren#
D . P,oultry -a a_c.ity P,o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Lavers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes FfNo ❑ 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 operarion?
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 )Zj No
❑ Yes PrNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Picgty Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Ej No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): lr4 9`
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
ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[71 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [:]No �NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No F."
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 0"NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
[:]Yes [:]No NA ❑ NE
[—]Yes [:]No NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
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?
Page 2 of 3
[:]Yes ❑ No
[:]Yes ❑ No
NA ❑ NE
/'NA ❑ NE
NA ❑ NE
Weather Code
❑ Sludge Survey
O'NA ❑ NE
PNA ❑ NE
21412011 Continued

acili Number: jDate 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes
[:]No
Vi NA
❑ NE
[:]Yes
[:]No
eNA
❑ NE
[:]Yes
❑ No
0 NA
❑ NE
❑ Yes ❑ No 0 NA ❑ NE
[:]Yes ❑ No 0 NA ❑ NE
❑ Yes ❑ No O NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[:]No
NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes
[:]No
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No
NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility
to better explain situations (use additional pages as necessary).
V 0 �- A
Reviewer/Inspector Name: �lhSl7 Phone:
Reviewer/Inspector Signature:Date:
Page 3 of 3 21412011

Type of visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ,, Arrival Time: Departure Time: t l County: Region:
Farm Name: AAbb_-1 - !ij Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: A 1 L A 1.11/Y &i4m
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
n 0�3
Certification Number: ") q-//vC
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design
Cattie Capacity
Da' Cow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
iv
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oultr,
La ers
Desiivpl!o
Ca a
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? [:]Yes C7r'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 0 No
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Fac' ' Number: - Date of Inspection:
Waste Collection & Treatment
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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
I7 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
ZrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VTNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
.] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
to
17. Does the facility lack adequate acreage for land application?
❑ Yes
r] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
�TNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2fNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [71 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 Nuinber: - 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
ZNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
F7'N0
❑ 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?
❑ Yes 0No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes P6 No ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes �No
❑ Yes TA No
❑ NA ❑ NE
❑ NA 0 NE
Reviewer/Inspector Name: 7'u,S� Phone: X12- 3bi1
Reviewer/Inspector Signature: J Date: W I T^ 13
Page 3 of 3 21412011

. I
FfaeilityNumbee
vision of Water Quality
O Division of Soil and; Water Conservation_,
Other Agency -
.;
Type of Visit pleo-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outme 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % 24r-rival Time: Departure Time: County: Region:
Farm Name: Owner Email: _
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: t h Integrator:
Certified Operator: Operator Certification Numberj � �PIZ
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c = 6 Longitude: C
Design Current°
"Swine " Capacity- Population -Wet Poultry . C
-
_ ❑ Wean to Finish V.❑ Layer
❑ Wean to Feeder 110 Non -La er
Design Ctirrent
epacity Populahori m Cati lei
7 Feeder to Finish
Farrow to Wean
�Dryl?oultry r � "�
-�
,] Farrow to Feeder -
❑ Farrow to Finish
❑ Gilts
❑ Boars
ILI Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
iry Cow
iry Calf
iry Heifer
v Cow
Beef Stocker
Beef Feeder
Beef Brood C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
o =,
❑ Yes P�qo ❑ NA ❑ NE
❑ Yes O'No
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
ElNA ElNE
❑ Yes
❑ Yes ;�No
❑ NA ❑ NE
❑ Yes ET -No
❑ NA ❑ NE
Page 1 of 3 12128104 Continued

:
[Facility Number: 71-.2=aU1 IDateafinspeciFon—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes,,D-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 U;:�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 'Jallo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Q-No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes J2'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes,-6No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 4 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes _C2'No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'[2-No
17. Does the facility lack adequate acreage for land application?
❑ Yes �-rj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
'J:�No
❑ Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ,ffNo
❑ 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. PYes ❑ No
❑ Waste Application ❑ Weekly Freeboard [Waste Analysis PKoil 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 P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: 7 Date of Inspection: ,Q
24.'Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ Yes jZfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ET —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 ONo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes J�J`No ❑ NA ❑ NE
[:)Yes P"No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes P &o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E-No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? El Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other -comments.
Use drawings of facility to better explain situations (use additional pages:as necessary}:
�
�-� way .pelp 2- /,05'
(a
Occ-
Q•0Z
0176
4�011( `, 3 7
c) 2-
0 "I %
Reviewer/Inspector Name: / Wu
Reviewer/Inspector Signature:
Page 3 of 3
wig f-ar
u M pbt5
�rl� aorZ.
G{ ,5 S a�S S�o�
05 S 11L !.
• �,� n ecz 'te a c 4rt' SP /
�- plqce- ,,n'- '01Q_re_ _
-'ter
Phone:
Date: /O l
21412011

° ivision of Water Quality
Facility Number - $) Division of Soil andkater irnservatim
Other Agency
Type of Visit: Psompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County
Farm Name: �� �� / J ! 5 (-,} Owner Email:
Owner Name: 'Zl us, -A, A LAj4 P_-.65 -ric— Phone:
Mailing Address: ) g % <.::� CCLAN-ra(A LLug �.-611 A94 U i LL , NG Q& 3 y01
Physical Address:
Facility Contact:
Title:
Onsite Representative: `l A UCy
Certified Operator: el ac
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
9(-ll1 Q
Design Current Design Current
Swine Capacity Pop. Wet. Poultry C>apacity Pop.
Wean to Finish I ILayer
11
Design C►urrent
Cattle Capacity P.
Dairy Cow
Wean to Feeder
Ll SO
INon-Layer I
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
ltry C•_a aci P,o ..
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
jNon-Layers
Beef Brood CowPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 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
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fd6lity Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4No ❑ 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: 1
Spillway?:
Designed Freeboard (in): q.
Observed Freeboard (in): Uo
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes P No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): }}C—A"f S I� Corrox _.— CaQ-N
13. Soil Type(s): E }l,ti%LkUI LL-tc—
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IoNo ❑ 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
oNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
[:]Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes jj No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 7j No [DNA ❑ NE
the appropriate box. T`
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Po ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Q Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Slud a Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: 5
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 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 kNA ❑ NE
Other Issues j
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
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
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
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 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments., --
Use drawings of facility to better explain situations (use additional pages as necessary)..
L >-(� 1
13/�a i. cO /. b 5.y
113/li `�. 1 �• 3 I 9
p5lo
Ig�TI LVV ��fG �� 3
���� SLAD6G 5uLuC� aU)c� C3X
C�
0c,
p1Td 5 C Pr' s'ooN
_S�s► SET a ��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: - r k1- _1l1194
Date: /OfpL
214,12011

Type of Visit: Compliance Inspection n Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: .Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: /r 1 Arrival Time: ® Departure Time: County: O� Region:
Farm Name: A j j {,xR Owner Email:
Owner Name: O S % ! C Phone: 910 COWL) Ch
Mailing Address: j `I S . CdLA.,Uya-LA, CL(AR 'lJQ YJZ:W4,VTUJLCC- ,/VC 0 CH
Physical Address:
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine @apacity Pop. Wet Poultry Capacity Pop.
Deslgn Current
Cattle Capacity Pop.
Finish
Layer
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
o Wean
o Feeder
o Finish
p
Design Current
I) , P,oult , Ca aci P,o
La ers
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Non -La ersBeef
Feeder
Pullets
Beef Brood Cow
Other
ME70—ther
T -keys
TurkeyPoults
Other
Discharges and Stream Impact
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,..1 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): .
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
4
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed through a
[:]Yes
§No
❑ NA
❑ NE
waste management or closure plan?
7TTCCCCCC
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 JXNo ❑ 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): „�Ld &4- I 4W-> Lp--TWI �Cou0z ]
13. Soil Type(s): Rck T(7 t1Uf_t-LF_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[]Yes
ONO
❑ NA
❑ NE
Required Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists ODesign Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No
0 Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑yste Transfers
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections Q 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
0 Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: [ - Date of Inspection: 3 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes X, No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA 0 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
Yes
❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
, �(
No
and report mortality rates that were higher than normal?
7�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
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
permit? (i.e., discharge, freeboard problems, over -application)
60
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Kj No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes tNo
o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ElYeso
❑ NA
❑ NE
NA
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #I): 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).
L 16w Y
DES16W 04.? 4 PrV P i
Fil66GOAM C-13j6-V's —
Iyc-c 1J `Jfc-'�
TU eq-(147
CLkT S�rM,µRiZ�S'FF�E1
To c6j 41v6r= F Q rQ
t - G Fi
G,gLr a )1 oM D(AC o90 CS
o9(, . C CoF � p F 00 l 61 C cAa n 4 F�.t? C,3 17 H ��oQDs
Cep eI MS c* (31C AC7)Utr
G. i , L-L- Gp L.L, 1 Q
�QSitC °k C 6T f4l M- KfVa� l'A0W [NSQ C i /0!t/ L.aEN/
T ff E�� t,� � s Ivor l4 GZ E et C_ S Env rR 7,* u � ON5'r T � -- 1 To:IA (i • 6a5 —1 c w M fW
4�gQT WAS SST 7f-4F�T iT WactiL -> (2 FINE 7a l�Avf R�CoQDS �N�E
Reviewer/Inspector Name: I` 1 OttA MoA A I N 6 S Phone: �6 '�td�3 d fi
Reviewer/Inspector Signature:Date:
Page 3 of 3 2/4/2011

Type of Visit $(compliance 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: q U Arrival Time: I--i - _l,�d 4� I. C4L7 Departure Time: County: ��� Lt �1 Region:
Farm Name: VCn AESI T nn) S�L�SE(_L[ Owner Email:
Owner Name: (ZI G1C_L►\ �N t(� 1�0571C Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: Integrator:
Certified Operator: eos 7 1C' Operator Certification Number: S" 19
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = ❑ , ❑" Longitude: 0 ° ❑, ❑
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder 40
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish L
L
Dry Poultry
Dairy heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Beef Feeder
Beef Brood CoAj
❑ Non -Layers
❑ Gilts
El Pullets.
El Boars❑
❑ Turke s
Other
❑Turke Poults
❑ Other
101 Other
Number of Structures:
Disc^ hares & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes *No El NA El NE
❑ Yes j No ❑ NA ❑ NE
12128104 Continued

Facility l Zumber: 31 — aR l
Date of Inspection I VIq__ D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: &L I _
❑ Yes No
❑ Yes ❑ No
Structure 5
[I NA ❑NE
El NA ❑N1
Structure 6
Spillway?:
Designed Freeboard (in): , S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 12rNo
❑ 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 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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) Wk (=fj- / S J3 C.O
13.
Soil type(s) 14L-t^I-Q,LA U I C-cC
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o El NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
ElNA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[IYesNo
❑ NA
jNo
❑ NE
17.
Does the facility lack adequate acreage for land application?
ElYeso
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yeso
❑ NA
❑ NE
.Comments (refer to question #): Explain any'YES answers an'dlor any°recomnendatinns_gr-any other omme to s "
Use drawings of facility to betterexplain situations (use.a'ddifidonal:pages as necessary)
Reviewer/Inspector Name j� VGs "` '>" Phone: 9��)
Reviewer/Inspector Signature: Date: yIRZZ6
Page 2 of 3 12128104 Continued

Facility Number: 1 —! Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ AFUp 0 Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑ Ay>sival Certification
El Rainfall [I Stocking El Crop Yield El120 Minute Inspections 0 Monthly and V Rain Inspections /El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 4 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
y
JJ No
�
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
)ok❑
NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
[]NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediateiy
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�alisjag
I/Va
�nF�? AN ctpQRTCn c(ZzV .)cr
Page 3 of 3 12,28104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y Q Arrival Time: ® Departure Time: County: Region:
Farm Name: ARE. I 1 ) SLAND N ARSF—eq Owner Email:
Owner Name — �IG_'2%U� c AAA 7IC. Phone: 1�-�//��! -,,gyp
Mailing Address: �� J ,�7 �—u% �2 1-3 %ti�AIf�SUj Z-LE,/ ��-- GY ��'"t
Physical Address:
Facility Contact: 1 Title:
Onsite Representative:
Certified Operator: UG A t:A>,i S7 it✓
Back-up Operator:
Phone No:
Integrator: (n�
Operator Certification Number: O y 1 1 oL
Back-up Certification Number:
Location of Farm: Latitude: 0 u = = Ii Longitude: = o = 6 = is
Design C*urrenf
Design Current
Design Current
Swine Eaapacity Population
Wet Poultry C�Fp7 Population
Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Paintry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Covi
❑ Turkeys
Other
0—Turkey Poults
❑Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo ❑ 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
No
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ 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�00AI
Spillway?:
Designed Freeboard (in): { 9' s
Observed Freeboard (in): `7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
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
K
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
XNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
jo No
ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ANo
❑ 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 di*elr from those designated in the CAWMP?
❑ Yes
1� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
%No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N[No
❑ NA
❑ NE
Comments (refer�to�questton #) Explam�any V ES answers andlor any recommendations or any other comments.
Use drawrngsoffaCdltyt better explarns�tuaftons. {nse addrhonal pages as,necessary,
.. �.
�•�• ��,,,�[�Elt1% WIC-F>�GAu�gTl�i�'T+i1S c��gSZ
gj�11a� a.o
Reviewer/Inspector Name F—f4 lvc A/e Phone: 916196
Reviewer/Inspector Signature:. Date:
Page 2 of 3 12128104 Continued

Faciliij;,,Number: f Date of Inspection 1VZ%L6i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑YesJz No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box. 0 ATUp 0 Checklists 3 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑/rinual Certification
El Rainfall 0 Stocking [D Crop Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�qNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
/$\
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
N
❑ NA
ElNE
.
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
XNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4 No
❑ NA
❑ NE
Page 3 of 3 12128104

p Division of Water Quality
Facility "Number Division of Soil and Water Conservation
- - - - O Other Agency ✓ "
Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 14 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `7 p2 0 Arrival Time: ® Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: (� Title:
Onsite Representative: _lam 1 �� DuST!2Y
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator•
L IN Region:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0 S Longitude: 0 ° ❑ ' ❑
Design Current' `De"sign Current` Designs Cirrentg4
Swine Capacity Population Wet Poultry: Capacity -Population Cattle -—Capacity Population;,
❑ Wean to Finish
❑ Layer
Wean to Feeder
❑Non -La er
❑ Feeder to Finish
i Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
j ❑ Layers
El Farrow to Finish
❑ Non -Layers
❑ Gilts
❑ Pullets
❑ Boars
1
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
--- - — — — ❑ Turkeys
Other urkey Poults
❑ Other Other Number of S ❑tructures
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
TgNo
❑ NA
❑ NE
❑ Yes
[(No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NNo
❑ 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: LA6
Spillway?:
Designed Freeboard (in): H .C5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�ZNo
❑ 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?
MYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
%No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes]
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[)I No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (useadditional pages as necessary):
. N�Eb Son1e ),tiGzT +- �FGET�► T)oAI A-gLO-) cID�.Fc�c� ��Nr_
�n[�c� d F /C>� SOl L S I�'l7 C d- �C�T C i] r �'
ET � J � Nt S
F_T CO?y �iir 54rti 1r R Ing( 1
of -1 Oct-, tA' 9Zr--c oaf Fad Q-LcaV% S IV]
Reviewer/Inspector Name P} _= I 6S - —� Phone: 9/6
Reviewer/Inspector Signature: Date: 9105 L _
Page 2 of 3 12128104 Continued

i,
Facility Number: —a Date of Inspection12J
Re uired 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 appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Wo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E�[No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ 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
J4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E[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
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
,J�rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
)dNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
'Division of Water Quality
O Division_'of Soil and'Water Conservation
O Other Agency
Type of Visit jD£ompliance 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: Regiont_�(
Farm Name: �� f Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phones No:
Integrator: % n_Z 5
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o Longitude: = o = � = H
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I Boars
Other
Non-L
Pullets
Other
Poults
Currei
rattle
Design ' Curr'ent,,
Capacity. Population'..
❑ Dairy Cow
El Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood Co
F.
Number,of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ,dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
VfNo
ElYes
Vic)
ElNA
❑ NE
❑ Yes
o
❑ NA
❑ NE
12128104 Continued

—_ ON --- Djjvision►o%Water Qualtty _tea
iFaeility Numbers Drvjsjon,oftS hand -Water Conservation .
Type of Visit g6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: ARegion
Farm Name: �ll t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phones No:Onsite Representative: Q Integrator: �1 n 11
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine Capacity Poi
a; ❑ Wean `toyFinish
❑ Wean to Feeder
[:]Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
f ` ❑ Gilts
' ❑ Boars
-O"lher
❑ Other
Latitude: [= c ❑ 1 Longitude: 0 ° = & =
fa Design Current
Wet 'Poultry Capacity Population Cattle
u =Non -Layer. -I__ e !
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current'
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: ED'
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
e9
❑ Yes �dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
❑NE
❑ Yes
VrNo
ElYes
4/j,
❑ NA
ElNE
❑Yes
6 0
❑NA
El NE
12128104 Continued

Facility Number; — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a, if yes, is waste level into the structural freeboard?
Struc�e 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 XON-o
❑ Yes ffNo
Structure 5
❑ NA [3'NE
❑ NA ❑ NE
Structure 6
❑ Yes PNo ❑ NA ❑ NE
❑ Yes J�'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWO
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 �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 T!fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PAo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I 2 No ElNA [INE
ElExcessive Ponding ElHydraulic Overload [IFrozen Ground [IHeavy 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
I2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'RNo
'PTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P__No
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or anyother comments:.
Use drawings of facility to better explain.situations...(use additional;pages as,necessary,)
Reviewer/Inspector Name 1
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
Date:
Continued

Facility Number: f -- Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ 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 El Checklists [I Design ❑Maps ❑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
0
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
P
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
gj�o
❑ 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
❑ 1
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] yes
�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
0No
❑ 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
UfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
47-1-1
Page 3 of 3 12128104

0 Division of water Quality
Facility Number a !J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review () Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: d Arrival Time: —a Departure Time: County: Region: (J I
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
64/,K AelzAr7
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: OC&
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 d=" Longitude: = o= 6 0
Design Current Design Current
`Swine .Capacity 'Population Wet Poultry Capacity Population
❑ Wean to Finish 10 Layer
Wean to Feeder ❑ Non -La er
❑ Feeder to Finish
` ❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other I
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pollts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field .. ❑ Other
a. Was the conveyance man-made?
Design Current;''-'
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �jNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
[�No
/El'No
El Yes
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 —'� 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 [K,lo ❑ NA ❑ NE
Stru ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Q'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[,-�'&o
❑ 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
0No
❑ 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
P[No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
;2 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
f 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
[;�bNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1PNo
❑ 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
;21No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1;2 No
❑ NA
❑ NE
Comments (refer to question #): Ex lain any YES answers and/or any recommendations or any other. Comments., = �
Use drawings of facility to better explain situations. (use additional pages as necessary):
—i�,► 1 K a 600'
y-
_
__ _
Reviewer/Inspector Name ,yr
_______ _ _ ___,� Phone: �•�� `7" �yZ
ReviewerAnspector Signature:
�. Date: i 6rG
Page 2 of 3 12/28/04 Continued

Yhtility Number: Date of Inspection RIF
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JO No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ❑ NE
the appropriate box. lu
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�3No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P[No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
? No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PINo
❑ 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
[INo
❑ NA
El 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
17No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
stt�ry ovP
Page 3 of 3 12128104

Type of Visit ' ,C.,00m� pllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit., Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name: —1
Owner Name: —
Mailing Address:
Physical Address:
Time:
0 /Departure Time: County:
' V eel: ' Owner Email:
Facility Contact: Title:
Onsite Representative:/Pt t: o•
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: [� o [ [� Longitude: 0 o =
Design Current Design Current
Design Current
Swine Capacity Population Wtet Poultry Capacity la .on Cattle
'Y�R'�P-u. Lam"'. -•. eN�e16ii1'8-:-
C p i Popplanon
_ a .,:.. ieN+a-A. - +. ?i+t}St i'Y.d3
❑ Wean to Finish ❑ La er ❑ Dairy Cow
can to Feeder ❑Non -La er ❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifei
Dry Poultry ❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑Non -La ers ❑ Beef Feeder
❑Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes �2h�o
❑ 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 EfNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes Z No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:31 Date of Inspection
rr
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):
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 XNo ❑ 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 ;?rNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,2rNo ❑ 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 RfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesZ'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 14% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes f5No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes,,&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes 2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes j2f?,lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;2No
❑ NA
❑ NE
Reviewer/Inspector Name �. GL f . -* r , Phone:
Reviewer/Inspector Signature: Date: d
12128164 Continued

Facility Nvniber: — Date of Inspection •�f-v/oy3
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 Z'No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists Design ❑ Maps
❑ Desi p 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 Yf120 Minute Inspections �onthly
and I" Rain Inspections ;?'Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes_..❑ No 01,IA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No j2rNA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No E�NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ;;rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes J?rNo ❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,2TNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes )no ❑ NA ❑ NE
and report the mortality rates that were higher than normal? �+
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �LI No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately .1e,
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 7No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes o ❑ NA ❑ NE
Additional Comments and/or Drawings:
af)rNease - Lecord
1 a rJvn Yl 5� 4c'r'
mow)) 6�a Q-CA-e,{' 1 fa)n-�t 1 5
Far,n i s i ✓t (3rea}- ,1��� ,records
a r¢. yea �- a-- e-) rckc I y
12128104

Type of Visit 'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0"'Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Id Tune: • tJ
O Not Operational O Bel
0 Permitted 0 Mi�
Conditio y C 0 Registered Date -Last Operated Aboa Threshold:Farm Name:ei........ County: -
Owner Name: _ _... _ W ..._ ....___ _ . _ . _ .._ ..... Phone No:
Mailing address:
Facility Contact: . .
Onsite Reoresentath
Certified Operator.
Location of Farm:
Title:. Phone
. ..... _ ...... Integrator: LCF
.. Operator Certification Number.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4
Discharges & StreannImpac
1. Is any discharge observed from any part of the operation? ❑ Yes A 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 galimin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ji No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B No
Identifier:
Freeboard (inches):
12112103
Structure I , Structure 2 Structure 3 Structure 4 Structure 5
a
Structure 6
Continued

Facility Number: — Date of inspection / /U
5. Are these any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes AH1 o
seepage, etc.)
6. Are there strictures on -site which are not properly addressed and/or managed through a waste management or
0 Yes &No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefumprovement?
❑ Yes .ffiko
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes Zlgo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes E50No
elevation markings?
Waste Application
10. Are there any buffers that need maintenauce/improvement?
❑ Yes 4!3 No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes 12-f4o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload zen Ground ❑ Copper and/or Zinc
12. Crop type 44
'
13. Do the receiving crops differ wuth those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ETRo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes gj-No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes -'Rio
16. Is there a lack of adequate waste application equipment?
❑ Yes 'I_l No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [j Yes 10140
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.,014o
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 ,,allo
Air Quality representative immediately.
.dG
T,lseAMCM aC P?: �] Field Copy ❑ Final Notes
•-.
- alsr� VL �� S a cs;llt a r
Ae�s y
Fo/,m /
Reviewer& pector Name ,� 1 z
Reviewe Anspector Signature: Date: $(J CJ
12112103 Cowed

Facility Number: Date of Inspection
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?
(ieJ 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?
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. 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 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes e-No
❑ Yes ZNo
0 Yes 'ONO
❑ Yes ;2140
❑ Yes Of4o
❑ Yes PrNo
❑ Yes .E71No
❑ Yes E!rNo
❑ Yes j2 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12/I2/03

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted [j Ce 'tied © Conditionally Certified 13Registered
Farm Name:
Owner Name:
Mailing Address:
Time:
Date Last Operated or Above Threshold: _
County:.�� _
Phone No:
Facility Contact: Title: Phone. No!
Onsite Representative: �(��y ����� _ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude ' 4
Wean to Feeder Ll L;
Feeder to Finish ❑ N
Farrow to Feeder U Other
Farrow to Finish
Boars
Subsurface Drains Present
No Liquid Waste Manaeen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Trea�tn e_nt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes INO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A No
❑ Yes XNo
❑ Yes )dNo
Structure b
Continued

Facility Number: — Z 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Awlication
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over anDlioation? ❑ ExcessivQ Ponding ❑,PAN ❑ Hydraac Overload
12. Crop type ���
13. Do the receiving cropsdiffer with those desi ated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Required Regards & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes Z;dNo
❑ Yes gNo
❑ Yes [/No
❑ Yes VNo
❑ Yes INO
❑ Yes o
❑ Yes / No
❑ Yes A No
❑ Yes �No
El Yes VNo
❑ Yes No
❑ Yes 0.No
El Yes PfNo
❑ Yes Y(1140
❑ Yes )'--' No
❑ Yes VNo
❑ Yes o
ElYes 9NO
❑ Yes X No
❑ Yes Y_']
o
❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

4
Facility Number: 28 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �Vo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes PNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [IYe ❑ No
Additional ornments and/or Drawings:
Y
05103101

(Type of Visit 79 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Fonow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: �of Time: 1 /1190
Facility Number )
ro Not O erational 0 Below 'Threshold
® Permitted MCertified © ConditionallyCertified
✓30iCertified [3 Registered Date Last Operated or Above Threshold:
FarmName: .........AA f._.s'`.1nj.....rNu............................................ County:........ �......................... ....._. .�.
1 ,�1 `� .....
OwnerName........ LC!� ... t(!.................................................................................. Phone No: ................. ._ ........_ .....� .... .. w _ _ .
FacilityContact:............................................................................... Title:................................................................ Phone No: ......... .
MailingAddress: ......................................................................................... -.......... ............................... .... ................ _...
Onsite Representative: ........ tJ/7.............................................................................. Integrator:... !!!k��Y..... !�t.�....
Y!��._ _
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 44 Longitude • 4 �u
Design Current :. Design Current Design ri:
Capacify Population `:: o- Ca C!
Wean to Feeder
z v
-:, ❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
EE
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design 'Capacity-_:
Total SSLW _
Ntiinber_of Ugoons I Y ❑ Subsurface Drains Present ❑ Lagoon Area . Spray Wield Area tw
Holdink Ponds / SoUd'.T' aps ;` (] No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ®No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [;3 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes (4No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ ................... ........... ......................... .................................... ............... .......... .....
...
Freeboard (inches):
5/00 ' Continued on back

Facility Number: Date of Inspection ¢
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes CK No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [NJ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
M No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
is No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
® No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
®,No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
-0 No
12. Crop type ,:�2 )6evo �%�Di? llb,4m/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
IR No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
(ffNo
b) Does the facility need a wettable acre determination?
`K Yes
❑ No
c) This facility is pended for a wettable acre determination?
gj Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
R3 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
®No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
1ZNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
P&No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®,No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
yi a�iQris:or- iforlde'ndes -vr1 ho e# di g �hjs:vlsjt; • Y;o> 91- ee�iye 4o u t#�gr
coriesborideike:ahbutithis' visit:.-::::::-:-"-.-.-.•.-.-.-.•...• .... .•.•.•:............. .
acility to,betterr eacpla . situations. (use additional pages as necessary)_ -�
FovA Ivlb/de" We/-L20-,i►11A.-/V011 due. %jt�rc�i
Wes4cvleek- "s e-ureert+17 lope -cill m -74;s.
'100KY't5 AtQ
It 4 A4in `i 4,
9V
Reviewer/Inspector Name�✓
7.
�n c Cam_ __ _ ..
-
_ a _
__
Reviewer/Inspector Signature: (fig/{ f Z'Ky_ -.e Date: //5 / 5100

Facility Number: - Date of Inspection O�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IQ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes R-No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®,No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ['No
I-MditionW Comments an or rawtngs:. ..
d&i
S/00

of Visit OO Compliance Inspection O Operation Review O Lagoon Evaluation
;Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 281 Date o1 Visit: 7-6-2fl�� Tone:E1500
Not Operational 0 Below Threshold
❑ Permitted MCertffied 13Conditionally Certified Megistered Date Last Operated or Above Threshold:
Farm Name: Rabbil.lsbuid.N urac y............................................... .. ... County: D.uplia....................................
Owner Name: Bjc4 ----------------------------- Bostic ------------------------------------------- Phone No: 41.Q116 QQ.�Q Q:ZQ�Z.i...............
Facility Contact- - -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- - -- - - Title: -- - -- -- -- -- -- -- - -- -- -- -- -- -- - Phone No: - -- - - -- - - -- - -- -- --
Mailing Address: 1�.olutb.C�tun�tlt3.�1t.D�ri�Ye.....................................
Onsite Re msentative• [�nexlt��-•--•--._..__....__....--•--.....-•--•--•--•--•--.._ Integrator- EaX. axa.--•--...._..--•--•--•-
Certified Operator:........_. __ Operator Certification Number_ _
Location of Farm:
North of Greenevers. On the right approx. 0.25 mile before the end of SR 1954 to the West of Hwy 50. +
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 34 ' S1 i' 46 u Longitude 77 ' S5 OS
Desrgn Current
Deittgn Current
Design Current
Swore Ca aci
1Poult
-
P ula>tioii ...Cattle................Ca
:.
ara :=Po ufafion...'.
® Wean to Feeder
2600'
:.
❑Layer
`
❑ Dairy
❑ Feeder to Finish
❑ Non -Layer
'
❑ Non -Dairy
❑ Farrow to Wean
`. -
❑ Farrow to Feeder
❑ Other
... .........
❑ Farrow to Finish
.
Total DesIg� Capae�ty
2,500
❑ Gilts
- :..
:... Total SSLW€
78,000
❑Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes 0 No
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..... _.. _.. _.. _.. _.. _.. _. - -.. _.. _.. _.. _.. _.. _......: _.. _.. _.. _.. _.. _.. _.. _.. ............. _.. _.. _.. _.. _ _.. _.. _.. _.............. _.. - - - .. _.. _ .
Freeboard (inches): -- -- -- - 34 - -- - - -- -- -- -- -- -- - -- -- - -- - - -- - -- -- -- -- -- -- -- - - -- -- -- -- -- -- -- --

.)iuv
Faciifiy Number: 31-281 Date of Inspection 7-6-200d
5. Are there any immediate threats to the integrity of any of the structures observed? (iet trees, severe erosion,
seepage, etc.)
6. Are there structures on -sits which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4fi 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 thanwaste structures require maintenance/improvement7
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed Corn, Soybeans, Wheat
Gonunuea on back
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
®No
Q Yes
® No
❑ Yes
No.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ® Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
N Yes © No
❑ Yes ® No
N Yes ❑ No
❑ Yes ® No
❑ Yes ® No
15. New areas of bermuda need to be sprigged next spring if done already. If done, then needs to be vastly improved with +
herbicide applications, lime, etc.
14/18. Obtain new aerial photo for farm from district or Murphy. Have waste plan amended based on new irrigation design &
crop changes. Farm pended for wetted acres — no map showing pulls & acreage calculations located in records. (Last
statement added after inspection)
19. Suggest taking new soil samples since lime is highly elevated since last report. Apply this fall according to analysis
results. Must account for commercial nitrogen applied to spray fields — subtract from beginning PAN balance.
Cont. >
Reviewer/Inspector Name

rCriCwCrJLUNP xwr 09gUAILUM: LuIC: S/UU
Facility Nimbi'-: 31-281 Date of Inspection 7�-2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ® Yes [] No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ® No
. No OIC designated for facility in database. Grower is re -certified after failing to pay annual fee. Forgot to leave OIC
signation form on -site. Will send via mail along with printout of this report. (Added after inspection)
Owner on -site for record review previous week — rained out from doing physical inspection. Notified grower of intent
orm rest of visit if he wished to attend which he did'not show up.
Lagoon has dike wall 10-12 feet high.
Tt"4� '�� "-0,- -J(:ri \

State of North Carolina VIED
Department of Environm nt Alu) t ® +
and Natural Resources
Michael F. Easley, Governor
William G. Ross Jr., Secretary NCDENR
Gregory J. Thorpe, Ph.D., Acting Director NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL REsOURCEs
August 9, 2001
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Ricky Bostic
Rabbit Island Nursery
193 South Country Club Drive
Kenansville NC 28349
Subject: Notification for Wettable Acre Determination
Animal Waste Management System
Rabbit Island Nursery
Facility Number 31-281
Duphn County
Dear Ricky Bostic:
A letter dated January 15, 1999 was sent to advise you about concerns associated with Certified Animal
Waste Management Plans and the method by which the irrigated acres within the plans were calculated. Only
the acres that are wetted can be credited in the waste management plan as receiving waste application. Any
acreage within the plan that can not be reached by waste application equipment can not be used as part of your
plan.
An evaluation by Dean Hunkele on 6/29/00 was made to review the actual number of acres at your
facility that receive animal waste during land application. The evaluation of your facility has yielded one of
the following two results as indicated by the box marked with an "Y'.
Cate ory 1:
The evaluation of your facility could not be completed due to a lack of information. Please
contact your Technical Specialist to assist in providing Dean Hunkele the necessary
information to potentially exempt your facility from undergoing a complete wettable acre
determination. Please submit this information to Dean Hunkele, at 127 Cardinal Drive
Extension, Wilmington, NC 28405-3845, within in 90 days of the receipt of this letter. If you
have any questions please contact Dean Hunkele at [phone]. If within 9D days you
are unable to provide Dean Hunkele with the information you are automatically
required to complete a Wettable Acre Determination as described by Category 2
below, within 180 days of receipt of this letter.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

Notification for Wettable Acre Determination
Animal Waste Management System
Page 2
Category 2:
❑ Your facility has been identified by the Department of Environment and Natural Resources
as a facility that may have overestimated the number of acres actually receiving animal
waste. Therefore, some or all of your fields may be exceeding -the allowable loading rates
set in your Certified Animal Waste Management Plan.
In order to resolve this issue, please contact a designated Technical Specialist to have him
or her conduct a Wettable Acre Determination for your facility. The Technical Specialist must
be one that has been approved by the Soil and Water Conservation Commission to conduct
Wettable Acre Determinations. Many Technical Specialist with the N.C. Cooperative Extension
Service, the Soil and Water Conservation Districts, the Natural Resources Conservation
Service, and the Division of Soil and Water Conservation have received this special
designation. You may also contact a private Technical Specialist who has received this
designation, or a Professional Engineer.
All needed modifications to your Animal Waste Management System must be made and
the Wettable Acres Determination Certification must be returned to DWO within the next
180 days. If the needed modifications are not made and if the form is not returned within the
required time, DWO will be forced to take appropriate enforcement actions to bring this facility
into compliance. These actions may include civil penalty assessments, permit revocation,
and/or injunctive relief.
Once a Wettable Acre Determination has been completed, a copy of the attached Wettable
Acre Determination Certification must be submitted to the address listed on the form. Please
note that both the owner and the Technical Specialist must sign the certification. A copy of all
the Wettable Acre Determination documentation that applies to your Waste Utilization Plan
must be kept at your facility. DWO and the Division of Soil & Water Conservation Staff will
review all documentation during their annual visit of your facility. An additional copy must by
kept on file at the local Soil & Water Conservation District Office. Please note that if you install
or modify your irrigation system, a designated Irrigation Specialist or a Professional Engineer
must also sign the Wettable Acre Determination Certification.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability -for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Sonya Avant of our
Central Office staff at [phone] ext. 571.
J. Thorpe, Ph.D.
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
Murphy Family Farms

j. . V
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Kerr T. Stevens, Director
RICKY BOSTIC
RABBIT ISLAND NURSERY
2907 S NC 50
BEULAVILLE NC 28518
Dear Mr- Bostic:
C1EIV�:�,;
APR 3 0 2001
BY:
April 26, 2001
1 • •
Emma
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No. AWS310281
Additional Information Request
Rabbit Island Nursery
Animal Waste Operation
DupIin County
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the
subject application. Additional information is required before we can continue our review. Please
address the following by May 26, 2001:
L Please have your technical specialist amend the waste application windows for the Corn,
Wheat rotation option on page 2, Table 1 and page 3, Table 2, of your WASTE
UTILIZATION PLAN (WUP). You have manure application on corn growing in March,
and the plan has the wheat still growing and being applied to, until April. Correct this on
both tables.
2. Please have your technical specialist describe in your WUP narrative on page 4, the 2-
year rotation of Corn -Wheat; and Soybean -Oat crops.
3. Please include the data shown from Leased acreage Table 2 of your WUP, in the Nutrient
Balance table showing the totals from Tables I and 2 of your Waste Utilization Plan
(WUP).
Please note that all WUP revisions must be signed and dated by both the owner and the
technical specialist.
Please reference the subject permit application number when providing the requested
information. All information should be signed, sealed, and submitted in duplicate to my attention at the
address below.
NCDENR-Non Discharge Permitting Unit (attn: Theresa Nartea)
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An -Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Application No. 3I -0281
Ricky Bostic
Page 2
The information requested by this letter must be submitted on or before May 26, 2001 or the
Division will return your application as incomplete in accordance with 15A N.C.A.C. 2H .0200 and your
facility will be considered to be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid
permit is a violation of North Carolina General Statute 143-215.1 and will subject you to the
enforcement authority of the Environmental Management Commission.
If you have any questions regarding this request, please call me at [phone], ext. 375.
Sincerely,
Theresa Nartea
Soil Scientist
Non -Discharge Permitting Unit
cc Wilmington.Regional-Office; Water Quality_
Permit File

Icons) waste/animal/year = 1,092.0 (tons) waste/year.
Fg,pn(PAI4
) Prod
uced Per Year
D-40 Ibs. PAN/animal/year = 1,2466 s. PAN/year. (PAN from N.C.
Tech
�e above amount of waste is a big job. You should plan time and have appropriate
nt to apply the waste in a timely manner
The following acreage will be needed for waste application based on the crop to be grown and
surface application:
Table 1: ACRES OWNED BY PRODUCER
Tract Field Soil Crop Lbs. N Acres Lbs. N
# No. Tvoe Per Acre . Utilized
March -Sept.
T71920
1
AuB
Bermuda (H)
27
4.00
1100
T7192-0
y/ Total [ 4.00 1,300.00 J
*This N is from anigal waste only. If nutrients from other sources such as commercial fertilizer are / 7
applied, they must be accounted for. N must be based on realistic yield expectation. �C b
NOTE: The applicator is cautioned that P and K may be over applied while meeting the N
requirements. Beginning in 1996 the Coastal Zone Management Act will require fanners in some
eastern counties of North Caroline to have a nutrient management plan that addresses all nutrients.
This plan only addresses Nitrogen.
Page 2

- ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with ad! -.cent iandowner must be attached)
(Required only if operator does not own adequate land (see
Required Specification 21)
T r1t Field Soil Crop Lbs. N Acres Lbs. N Month of
N TVDe Per Acre* Utilized ADDlication
-r71 g21
/1
AuB
Corn
�,go 1 %-
4.00
360
- March -July
T71921
/ -1
AuB
Wheat
i.',72 1
4.00
288
Sept. -April
T71921
-1
AuB
Soybeans
t ` 0 i/'
4.00
360
may -August,
T71921
-1
AuB
Oats
L-' 5,Z S1,.
, 4.0
208
Sept. -April
T4295
AuB
Com
is '9,0
5.50
495
,; March -Jul
T4295
1
AuB
Wheat
f,172
5,50
396
Sept. -April
T4295 '
-1
AuB
Soybeans
5.50
495
May -August
T4295
-1
AuB
Oats
'52
5.50
286
Sept.- ril
j
0
0
T4295
2
AuB j
Bermuda (H)
1
4.00
1100
March -Sept.
T4295
717 -2
AuB
Small Grain
/ /50
4.Q0 '
200
Sept. -April-.
Total
' See footnote for Table 1.
Totals from above Tabfes
Acres Lbs. N
Utilized
Table 1 4.001 1,300.00
Table 2 1915 j
Total 4.00 1,300.00
Amount of N Produced 1,248.00
Surplus or Deficit (52.00) 0
VLJ
sa sB s
L (� (� C 00 O C (t`c S� CA/-O L
!VOTE. The Waste Utilization Plan must contain provisions for periodic land application of sludge at �,U� ��"` '✓
agronomic rates. The sludge will be nutrient rich and will require precautionary measures to prevent over
application of nutrient or other elements.
Page 3

State of North Carolina
Department of Environme
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Ricky Bostic
Rabbit Island Nursery
2907 S NC 50
Beulaville NC 28518
Farm Number: 31 - 281
Dear Ricky Bostic:
01'r
z Md
DEC 1
NCDENR
NORTH CAROLINA DEPARTMENT OF
' ENVIRONMENT AND NATURAL RESOURCES
December 13, 2000
You are hereby notified that Rabbit Island Nursery, in accordance with G.S. 143-215.IOC, must apply for coverage
under an Animal Waste Operation General Permit. Upon receipt of this Ietter, your farm has sixty (60) days to submit the
attached application and all supporting documentation. In accordance with Chapter 626 of 1995 Session Laws (Regular
Session 1996), Section 19(c)(2), any owner or operator who fails to submit an application by the date specified by the
Department SHALL NOT OPERATE the animal waste system after the specified date. Your application must be
returned within sixty (60) days of receipt of this letter. Failure to submit the application as required may also subject your
facility to a civil penalty and other enforcement actions for each day the facility is operated following the due date of the
application.
The attached application has been partially completed using information listed in your Animal Waste Management
Plan Certification Form. If any of the general or operation information listed is incorrect please make corrections as noted on
the application before returning the application package. The signed original application, one copy of the signed application,
two copies of a general location map, and two copies of the Certified Animal Waste Management Plan must be returned to
complete the application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
1617Mail Service Center
Raleigh, NC 27699-1617
If you have any questions concerning this letter, please call Theresa Nartea at [phone] extension 375 or
Stoney Manhis with the Wilmington Regional Office at [phone].
ncerely,
for Kerr T. Stevens
CC' Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Revised Apri 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 'S --�
Farm Name:
On -Site Representative: lt qX`Z
InspectorlReviewer's Name:
Date of site visit:_
Date of most recent WUP: T)
Annual farm PAN deficit: pounds
Operation is flagged for a wettable
acre determination due to failure of
Part If eligibility item(s) F1 F2 F3 F4
4111 Operation not required to secure WA
determination at this time based on
exemption E1 Q!4 E3 E4
Operation pended for wettable acre
determination based on ` D P2 P3
Irrigation System(s)- circle #0hard-hose traveler, 2. center:pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
F. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map'depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating, parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part I1- F1 F2 F3, before. completing computational .table in Part Ill).
PART Ii. 7a%).-Rule.EIigibil;t'y-ChcckIirl-P:nµ. l�bcuip�aritaiiE,n-r:►; wvrA Veteiriiinzticr -
Requirements. WA Determination.required.because.operation fails :one of.the.eligibility
requirements listed below:
F1 Lack.ofmcreage-whichTesuf#edin:over.pplication-zf_wastewater,(PAN) onmpray,
fields)according-fofarm'sdasttwo -years mf rrigation-xecords:
_ F2 Unclearjllegible, or lack of -information/map.
F3 Obvious­field:limitaiions-(nurn erous_ditches;failure:to=deductTequire d-L.,
bufrerisetback:acreage;-or25%'.of#otal_acreageadentitiedan LAWMP.:rncludes _---
small ;-irregulady-shapedfelds-.fields:iessfhan-5�cresfor�travelers_odessfhan
2 acres-for..stationarymprinklers).
F4 WA determination required because CAWMP credits f eld(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

Revised April 20, 1999
Facility Number _
Part 111. Field by Field Determination of
75% Exemption Rule for WA Determination
TRACT I
NUMBER
FIELD
NUMBER',2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
I
-
I
I
I I
I
I
I
I
I
I
I
I
I
f
I
I
I
I
I
I
I
I
i
t
!
I
!
!
1
I
FIELD NUMBER' - hvdrant, ^��►.1,-,Dire.. -:pU'sr,#r.arr►bars may he used in +lace of 1_nld numa,^�_p�nding.can.�.2V�`tut�.. .r
Yir1 ! Pe _i? C uii .i� S}': i' 1, is "i S�. i [L.'i ]'1:5:iTO )iti::'edil 07 ie ir,; 'J� Iris E?ciurirevlBWer will have t0 CC)ml}iRP fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acreage-exceeding=75% of its total:acres and havingreceived less ih2n 50%
of its annual PAN as documented in the#arm'sprevious-two years' (1997 & .1998) of irrigation -records, -cannot serve -as -the
sole basis-forrequiring a WA Determinatiori:-Back-upfields-must -be noted in the commentzec[ionand must -be accessible
by irrigation -system.
Part IV. Pending WA Determinations -
Pi Plan.Iacks:following-information: keJ V�
P2 Plan -revision -may-satisfy-7.5% rule based an adequate Overall PAN deficit and by
adjusting -all fiield:acreageto below 75% use rate
P3 Other (ielin process of installing new irrigation system):

Routine O Com laint O Follow-up of DW2 inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
Vermitted Certified 0 Conditionally Certified 0 Registered JE3 Not Operational Date Last Operated:
FarmName: .......�. ...................................... County: ................11.ir................................ .......................
Owner Name: ---------------- --- - ---------------------------- Phone No:
Facility Contact: .............................................................................. Title: .................. Phone No:
..............................................
MailingAddress:...................................................... .. Q .................... ........... ............. ........• ...........•... •----...---....... ..........................
Onsite Representative:... , `ems. ... Integrator:.... t^.. ........
.......................... ..................................................
Certified Operator: ..................................:.......................................................................:..... Operator Certification Number: ..........................................
Location of Farm:
Latitude • 4 66 Longitude ' 6 064
= Desrgn' _, Current Design Current Design Current%
;$wine = - -- Capacity,_°`Population, Poultry. _ Captiatyw Popula�on'= •_ Cattle `Capacity Population
Wean to Feeder
oa6CCJ
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
❑ Non -Layer '" ❑ Non -Dairy
❑ `
" Other _
_ e
DeSlri'Ca�faGlty'ry;
Total_,SSLW
:n-
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area -:
Holding Ponds^% Solid Traps = ' ❑ No Liquid Waste Management System x
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ..............
.. ................... .................................... ................................... ................................ .... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes N No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes 0 No
Structure 6
❑ Yes KNo
Continued on back
3/23/99
. a
•.�i� f � rx at .

Facility Number: — Date of Inspection
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type 6� r dal 1
13. Do the receiving crops diffe with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
a yi laiicjns:ot' deficiencies •Wre 0WO ¢trririg Ns.visit..:Y:OIF Wiil•keeeiiye fib further ;
tirres oridence ahhut. this :visit:
❑ Yes XNo
❑ Yes XNo
[-]Yes )K(No
❑ Yes D'No
❑ Yes V,No
[]Yes (�<No
❑ Yes 9No
❑ Yes �r&o
❑ Yes ❑ No
❑ Yes ❑ No
15�Yes ❑ No
❑ Yes 'qNo
❑ Yes �<No
❑ Yes �KNo
❑ Yes KNo
❑ Yes D<No
❑ Yes tKNo
❑ Yes PNo
9Yes ❑ No
❑ Yes ONo
❑ Yes ❑ No
Cominenis'(refer to question #) `Explain-anyYES answers and/or any -recommendations or:any other comments: _
Use drawings orfacility, to better explain situations (use"addrttonal pages as necessary) „ q F
711 -4-
Ak
w
Reviewer/Inspector Name
Reviewer/Inspector signature: �Q� �� Date:�QD

Facility Number: Date of Impection 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Kles ❑ No
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes PNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JKNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes gNo
Additional,Comments: and/or Drawings:r
P_- -
1 j
A.
Ac"
�
s
J

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Ricky Bostic
Rabbit Island Nursery
2907 S NC 50
Beulaville NC 28519
Dear Ricky Bostic:
IT4 •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-281
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRR1, IRR2, DRY1, DRY2, DRYS, SLUR1, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerely
U(
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% past -consumer paper

Division of Soil and Water Conservation `- Operation Review
Division of Soil and Water Conservation -.Com Lance. - inspectro
Division of Water,Qualrty Contliliance In_spectioii
DOther Agency - Operahart Review z•
MRoutine Q Complaint Q Follow --up of DWQ inspection Q Follow-up of DSV4C review Q Other i
Facility Number Date of Inspection
Time of Inspection tz,
Q 124 hr. (hh:mm)
© Permitted "Certified © Conditionally Certified [3 Registered [3 Not O erational Date List Operated:
'ln-� • l
Farm Name: P-A. DS3...l.T.---..LS17A.7"..l)......k-1t -5. -`�q County:......... .Ca..l .l..l...L^1....................................
Owner Name:..-.....................13.Q...T...t G .................
Facility Contact: ......................................................1......I................ Title:
Phone No: ... • Li..O....... 2.-.9.e...
3.�..............
.... ..-....I ............. Phone No:.-.......................
Mailing Address: 2n-077......S.C1 VT i.......IA..C....... .... 5.I0............. �.�.� ?.�f�.V...L.l._.L. �.�.�1/I G..... l�
Onsite Representative:..- ... yL .............................. .............. .......... I...........
Certified Operator:,,,.i... ............}.QS.T.�G Operator Certification Number:....
.........
Location of Farm:
••.L •..1. ..R..L..T...... ....... ..�'J 1.A D-..-.- ..i...R.. i.......... JC.. .•w•••!•........ .. 1. .. ........ i...Y...l...........5.. .....I. ...K.. ............A.
.................. f
i
--i
`........n�n..1.� _� ....... .t-z.' .......t-�..�..Cr.t-r. is t c ....... �?...... �+,,....... n-....1._S. ;.............................
Latitude ®'° ��� Longitude'
Design Current _;"" =Design . Current Design , Current
Swine "=, �� ,�
Poultry= Capacity Population Cattle Ca acity Population
CapacityPo ulation`
Wean to Feeder ❑ Layer ❑ Dairy
[:]Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean -
❑ ❑ Farrow to Feeder Other ;
❑ Farrow to Finish e Total Design Capacity d
- Gilts,
,. -
❑ Boars
- - -.­Tota1.SSLW
Number of. -Lagoons jE1 Subsurface Drains Present 10 Lagoon Area 10 Spray Field Area ;
`Holding=Ponds / Solid'Traps E= ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes CKNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ........
❑ Yes XNo
❑ Yes *0
❑ Yes )5(No
❑ Yes DNo
❑ Yes ❑ No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
[:]Yes XNo
Continued on back

Facility Number: —201hate of Inspection
6. `Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes -No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes PkVo
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes MNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? XYes ❑ No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes KNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N(No
b) Does the facility need a wettable acre determination?
❑ Yes
r'No
c) This facility is pended for a wettable acre determination?
❑ Yes
XNo
15. Does the receiving crop need improvement?
❑ Yes
gNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ,�No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? XYes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes CEkNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONo
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes iVo
0: Rio yiolaiigns:o..... n... were ... is:v.. Yoir W1�� C eeell+e il0 fllI thei'
corres}�oncience. about this visit. .
Comments {refer fo' question #):_'Explain -;any YES answers "and/oe any rectimmeindatrons oraany"_ollier coiiments:= _
Use drawings of facility to betterexplain,situatioas (use addrdonal pages as necessary)
l C) L A t� D A P 1? t_.`t' '� O GL_OS 5_17!)-_ Tt-t-^ t--� L C7 O 1= lam -"+ j •
W /A t--%-r-, l-.1.W C ► t - ,
•ZO . S'�— I*_ C-o':C-tnT -1`0 r f O
Reviewer/Inspector Name i _.
Reviewer/Inspector Signature: t—I� C_ _4 �� I r A w_0 n Date: I(, q q q
3/23/99

Fa-Vity Number: --Z Date of Inspection Ci
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes SAo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes $(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes N0
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes %'N o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 3<No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? )Yes ❑ No
Additional Coinaments; an or Fgyvings . = "_
Q O S T! L W t I!L C� O ra-ra�4_
•
r' fz0 C3 t-
P E 0 3 S U C3A tz-T`
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O D O �CSS AD
C-. tl A h G-�
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PH0-X"k-
3123/99
n

a w� 3
�Y ' 3 �

l
RECEIVED MAR A 4 190
FORM IRR-2 Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
a"do.we
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Facility Number I 3 - I P $1
Irrigation Operator c
Irrigation Operator's I
Address at5!$
Operator's Phone # 0101 -;g I
From Waste Utilization Plan
Crop Type Recommended PAN Loading } ff
(blacre) _ 10)
u1 r71 1111 ref r51 (Al rn rR1 191 r101 f111
1
Date
mrNddlyr
Irrigation
Waste Analysis PAN'
(Ib11000 gal)
PAN Applied
(Iblacre)
gf 1 ■ (9)
1000
Nitrogen Balance'
(Iblacre)
R • 00)
Start Time
End Time
Total
Minutes
(3) - (Z)
0 of Sprinklers
Operating
Flow Rate
(gallmin)
Total Volume
(gallons)
(B) " (5) " (4)
Volume
per Acre
(gallacre)
(7_)
(A
0
lJb ?A
$ w FA
O
1
o
1Q 200
go bo
o9.
db ?A
j1-6-1 EM
0
%a
600
10
o
d
D
a
oo
Crop Cycle Totals 157, hoe ! j 4?R._!2- --A
Owner's Signature, 'y Operalor's Signature
Certified Operator (Print) ,L Operator's Certification No. g 7
r
i NCDA Waste Anaylysis or Equivalent or MRCS Estimate, Technical Guide Section 633.
Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigalion event.

FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owners Address
Owner's Phone #
R AC.E I V E 1D MAR R 4 1999
agoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
11g2
; 3
' cr
Facility Number I 3 - I ZZ Fr I
Irrigation Operator t as `c.
irrigation Operator's
Address
Operator's Phone # p a gq - -7101
From Waste Utilization Plan
Crop Type Recommended PAN Loading
aaSS (1Wacre) = tn, 1 56 16rAG�2
1n r2t 131 ret 151 rat rn rat r9t trot (11)
Date
mmlddlyr
Irrigation
Waste Analysis PAN
(IWl000 gat)
PAN tiApplied
ppplli d
(Ib re)
t 00D
Nitrogen Balance
{B) 2 (to)
Start Time
End Time
Total
Minules
(3) - (2)
0 of Sprinklers
Operating
Flow Rate
(low R n )
Total Volume
(gallons)
(6) ■ (5) w (4)
Volume
per Acre
(gaVacre)
AZ .
(A)
10126
'oa rm
S"POPM
OWO
zoo
q0600
' o
lao PM
JD
D
too
a
2
o "144
30 PA
-pm
D
oD
goD
,o
+ r2
2 Crop Cycle Totals 157 ,bbo f 1 CC,9 1 Z- 1
Owners Signature 1 �6aE'sc�¢ Operator's Signature
v
Certified Operator (Print) g ` Operator's Certification No. y
NCOA Waste Anayiysis or Equivalent or NRCS Estimate, T ezhni a; Guide Section E;n.
Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event.

ItEC E I E ID MAR b j @0
FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owners Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
LL.i ti...k
T a4
C
Aue
L�.IA rl� C
�ifo 4 3211
Facility Number I - I a e 1
Irrigation Operator IC 5 iC
Irrigation Operator's Address t Q C- Z4,5419
Operator's Phone # q o
From Waste Utilization Plan
Crop Type Reoommended PAN Loading
,L5S (Iblacre) v (R} 5o i6iA4!'¢-
(t} (2) (3) (41 1`51 (et nt rat (91 r101 (tf)
Dale
rnnVddlyr
Irrigation
Waste PAN'
(10000 gal)
PAN Applied
(Iblaue)
6
'i 1 0
Nitrogen Balance'
(Ibracre)
{Bj - {t0)
5isrt Tune
End Time
Total
Minutes
(3) - (2)
p of Sprinklers
Operating
Flow hate
(gaBmin )
Total Volume
(gallons)
(s) " (5) " (4)
Volume
per Acre
(gavacre)
M
(A
o a6
lf: 3d P
: a
r
d
2-a �
O
a1 �.
jQj,RqZ,17
.a
t D i
0
916
jq ZOO
D
,
Crop Cycle Totals 1 38,400 j
Owners Signature Operator's Signature
Certified Operator (Print) Operators Certification No.
A
1 N--JH Waste Anaylysis of ,()uivaien: z! N RCS Esiimnale, ! e hni a! 'Guise �9u117
2 Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event.

FORM IRR-Z
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
RECEIVED MAR n 4 1996
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
LL-1,--p
'-5 5
F,1
,5 1 93 4,,-es
B., `L
11euK LJ &
o aS - 1
Facility Number - 1
Irrigation Operator K Ie-
Irrigation Operator's 44
Address IB
Operator's Phone #
From Waste Utilization Plan
Crop Type' Recommended PAN Loading
R GrAS $ 1 (Ibracre) = (s) 5Q b acre
frl (21 131 141 At 181 m rat rot rim fill
Date
mrNddryr
Irrigation
Waste Analysis PAN'
([bll0pp gal)
PAN Applied
(Iblacre)
8{ 1 A(1
low(3)
Nitrogen Balance'
(Ibracre)
(B) - (1 p)
Start Time
End Time
Total
Minuses
- (2)
of Sprinklers
OperalinQ
Flow Rale
{galrmin)
Total Volume
(gallons)
(f1) * (5) " (A)
Volume
per Acre
(gatJacre)
.. IL
A
to �, -r
k.o� ern
St•� ern
a D
i
$a
o
10,1067
x
:oo
$:OD Al
D
Z4 o
0 66
. Z
Crop Cycle Totals I 56 ),foo I , Z
Owners Signature Operator's Signature
Certified Operator (Print) 'z ' Operator's Certification No.
w
1 NCDA Waste Anaylysis or Equivalent o. NRCIS Estimate, Technical Guide Section 633.
2 Enter the value received by subtracting column (10) from (6). Continue subtracting column (10) from column (11) following each irrigation event.

l �
RECEIVED MAR n 4 199$
FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owners Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
r
. I ,
Facility Number 1 3 j 1- 1 .29-
Irrigation Operator c '
Irrigation Operator's
Address ` 11g, Ne— a S5
Operators Phone # It
From Waste Utilization Plan
Crop Type Recommended PAN Loading
i L i3 (IWacre) _ (B) 1570
tit [21 M r41 PSI Nil 171 rRti rat nn1 [tlf
Date
rrrrnlddJyr
Irrigation
Waste Analysis PAN '
(1br'too0 gat)
PAN Applied
(lblacre)
9 �
0�04
Nitrogen Balance'
(lb/acre)
(B) - 00)
Start Tlme
End Time
Total
Minutes
Ik or Sprinklero
Operating
g
Flow Rate
low Rn
Total Volume
{gallons)
Volume
per Acre
(gaVacre)
(A
7
ao
p
0
9 Oo
�.
.�$, 6
,Z�f•
7
k
Crop Cycle Totals 1 3il ,40 0 1
Ownefs Signature Operators Signature
Certified Operator (Print) 9-(Ickf Operator's Certification No.
r
td'r DA VVa z1,e Ar,ay:ys:Z ur E q u i v aien! 0 I\,^'. 7 f' i', C'� l :.� is G jiiJ
2 Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event.