090102_INSPECTIONS_20171231

I
PLAN OF ACTION(PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number: 009-102 County: Bladen
Facility Name: Neill Jackson
Certified Operator Name: Operator Number:
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4 Lagoon 5
Lagoon Name/ID: Main hole
Spillway(Y or N):
Level(inches):
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures.
Five and 30 day Plans of Action are attached. Hydraulic and agronomic balances are
within acceptable ranges.
X Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A
30 day Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste
to be pumped and hauled is reflected in section III tables. Included within this plan is a list
of the proposed sites with related facility numbers, number of acres and receiving crop
information. Contact and secure approval from the DWQ prior to transfer of waste to a site
not covered in the facility's CAWMP.
Operation will be partially or fully depopulated.
*Attach a complete schedule with corresponding animal units and dates for depopulation
*if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: as field and weather conditions
I hereby certify that I have reviewed the information listed above and included within the
attached plan of Action, and to the best of my knowledge and ability, the information is
accurate and correct.
Phone:
Facility Owner/Manager (print)
Date:
Facility Owner/Manager (signature)

Date of Visit: r% Arrival Time: (% 'n Departure Time: ,'v D County: Region: F��D
Farm Name: A4e; �f ;rlfe'fCS x -� �►r/� Owner Email:
Owner Name: ��� �� i z Phone:
Mailing Address:
Physical Address:
Facility Contact: % Grp �''-�- Title: &PWh e Phone:
Onsite Representative: Integrator: 4 f- /—
Certified Operator: f.«� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Calm aci Po
P h' P•
Design Eurren
Wet Poult , Ca aci Po
ry P h' P•
esiggILUb urrent
Cattle Ca aci Po
Wean to Finish
La er
Dairy Cow
Wean to Feeder
—0
Nan -La er
Dairy Calf
Feeder to Finish
up
0
Dairy Heifer
Dry Cow
Farrow to Wean
Design Current
Farrow to Feeder
D . Paul @a aci P,o .
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
7,1
..
Turkeys
Othe
Turkey Poults
Other
-sue.
•,.�
u� „�•.�
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?
❑ Yes Pj.No ❑ NA ❑ NE
[-]Yes [—]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes [2-'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes RLNo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

i
Facili Number: 1W jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes S-No ❑ NA 0 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): �Le
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 trecs, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ 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
PUI, No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s): 7,,-1'm u c! /O t/ -ems
13. Soil Type(s): C?
14. Do the receiving crops differ from those designated in the CAWMP? [ Yes F17-f No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
EINo
❑ 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 EjNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii 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 [2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes ff�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C!3,No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
O-No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
KNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[allo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
❑ Yes Lj4-No ❑ NA ❑ NE
❑ Yes O_No ❑ NA ❑ NE
❑ Yes E[ No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes 0 No
[:]Yes JZ No
❑ Yes LNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone:
Date:
21412015

Type of Visit: D<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: // ;V County: ,�� . y Region: �_
Farm Name: P j j _(�Q G�CS?r �Q,/ Owner Email:
Owner Name:, S 0 .—� Phone:
Mailing Address:
Physical Address:
Facility Contact: %�� i �� 5 1;1-w Title: e5�9 t&,,7 >—✓ Phone:
Onsite Representative: integrator: ��•/��yy�j�yc
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
mum }_
Design Current Design Current .: Design Current
Swine Capacity Pop.: Wet Poultry Capacity Pop: Cattle Capacity Pop.
__ . �.
Wean to Finish
Wean to Feeder
La er
Non -La er I
{4
Dai Cow
Da'y Calf
Feeder to Finish
Farrow to Wean
6,Z,7a Q
Design Currents
Dairy Heifer
Dry Cow
Farrow to Feeder
D , P,oultr Ca a_city Pl P,o L=...,
,.
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_
Qther
-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 JZ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes] No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number. jDate of Inspection-
7—
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LEI -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
ES No
❑ NA
❑ NE
(i.e... large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
to
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E2�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J&No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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 EgNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 1E[No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 0No ❑ NA [] NE
IS. Is there a lack of properly operating waste application equipment? ❑ Yes j, No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes LNo ❑ 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 Eg-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes 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 21412015 Continued

Facility Number: - :9:= 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 [a 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 ERNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [allo ❑ 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 GAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes [3,No ❑ NA ❑ NE
❑ Yes E,No ❑ NA ❑ NE
[:]Yes 0 No
❑ Yes ZLNo
j`es 42;P-No
❑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).
Cf�/7 �zG�✓ � <,+�--`L >'.i�r � C� /`t'rnv y-� � }-' r .'/ /� � �ic%'S � �� w �-._.
77
17
l.C11
Reviewer/Inspector Name: j__
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: / ,?
21412015

A _/
no F esources
ility Number - vy 0 Division of Soil and
Water Ganservation
- - DQ Other Agency
Type of Visit: Q<ompfiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (ram Arrival Time: fl Departure Time: County: .1
Farm Name: %V ,!-"! / Va+Gk$t)raf r-p-- Owner Email:
Owner Name: _J tv 1 / aCs p----- Phone:
Mailing Address:
Physical Address:
Facility Contact: /`- r % 7Gk__s-0-' Title:
Onsite Representative: J'o—c— Integrator:
Phone:
Certified Operator: -11, -ems Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude: .
Region: l�
Design
C•arrent
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
ci
Non -La er
Da Calf
Feeder to Finish
&00
1
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P.oul
Ca aei
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ON
Turkeys
Other
Turkey Poults
rdl Other
I
10ther
Discharges and Stream lmaacts
I . is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
SNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: -— Date of Inspection: d
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes jL No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes 12 No ❑ NA ❑ NE
❑ Yes U�_No ❑ NA ❑ NE
0 Yes allo
[—]Yes ® No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question-#): Explain any -YES ahswer - and/or any additionalFreconymendations orany'other comments
Use :drawings of;facitity to better explain situations:_{ase,add�t,bnal pages as .neceisary,)_, ,
/-:--;, ;S'/"r T ,
T; m r-.
A v
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ph�t.D
21412014

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r_:11 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �Z 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
[5 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
� Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
J C Yes
[:]No
❑ 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 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):�/'/Y1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fo 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 [3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 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 UNo
❑ 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 allo
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Ea No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

G�d 7,I c�
PLAN OF ACTION(PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number: 009-102
Facility Name: Neill Jackson
Certified Operator Name:
County: Bladen
Operator Number:
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4 Lagoon 5
Lagoon Name/ID: Main hole
Spillway(Y or N):
Level(inches):
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures.
Five and 30 day Plans of Action are attached. Hydraulic and agronomic balances are
within acceptable ranges.
X Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A
30 day Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste
to be pumped and hauled is reflected in section III tables. Included within this plan is a list
of the proposed sites with related facility numbers, number of acres and receiving crop
information. Contact and secure approval from the DWQ prior to transfer of waste to a site
not covered in the facility's CAWMP.
Operation will be partially or fully depopulated.
;Attach a complete schedule with corresponding animal units and dates for depopulation
'if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: as field and weather conditions permit
I hereby certify that I have reviewed the information listed above and included within the
attached Plan of Action, and to the best of my knowledge and ability, the information is
accurate and correct.
Phone:
Facility Owner/Manager (print)
Date:
Facility Owner/Manager (signature)

r*
f
f•
11. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YR.124
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1_ Structure ID: Main Hole
line m =
89.6 lb PAN
2. Structure ID:
line m =
lb PAN
3. Structure ID:
line m =
lb PAN
4. Structure ID:
line m =
lb PAN
5. Structure ID:
line m =
lb PAN
6. Structure ID:
line m =
lb PAN
n.lines 1+2+3+4+5+6= 89.6lbPAN
Ill. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAY DRAW DOWN
PERIOD. DO NOT LIST
FIELDS TO WHICH PAN
CANNOT BE APPLIED DURING THIS 30
DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s. remaining IRR
2 PAN balance
(lblacre)
L TOTAL PAN
BALANCE FOR
FIELD (lbs.)
column r x s
u. application window'
5368
1
Bermuda Pasture
10.50
230.00
2415.0
March-Oct-
v. Total PAN
available for all fields
(sum of column 0 2415.0 lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (line n from section 11) = 89.6 lb. PAN
x. Crop's remaining PAN balance (line v from section Ill) = 2415.0 lb. PAN
y. Overall PAN balance (w - x) = -2325 lb. PAN
Line y must show as a deficit. If line y does not show as a deficit, list course of action here including pump and
haul, depopulation, herd reduction, etc. For pump & haul and herd reduction options, recalculate new PAN
based on new information. If new fields are to be included as an option for lowering lagoon level, add these
fields to the PAN balance table and recalculate the overall PAN balance. If animal waste is to be hauled to

another permitted facility, provide information regarding the herd population and lagoon freeboard levels at the
receiving facility.
Make sure fields are dry enough to receive waste application.

NCDASCS Agronomic Division Phone: [phone] Website: www.neagr.gov/agronomcl FY15-WO04587
�'`` I�''•
Predictive
Client: Ernest Smith Farms
PO Box741
Advisor. ,
Waste Report
Garland, NC 28441
s r . ►
A
�f
-h'r til1r111"'-
Sampled.,
aacatved: 02/05/2015 Complet d: 02/16/2015
Bladen County
Farm:
Links o Helpful Information
Sample Information
Nutrient and Other Measurements
Nitrogen (N) (ppm) P (ppm) K (ppm) Ca (ppm) Mq (ppm)
S (ppm) Fe (ppm) Mn (ppm)
Zn (ppm) Cu (ppm) B (ppm) Na (ppm) C (ppm)
Sample ID: NJACK
Total N 43.5 251 41.6 28.0
8.87 0.79 0,21
0.24 0.32 0.21 62.5
Waste Coda: ALS
Description:
Total Kjeldahl N 163 = ....................
.. .. ...........................
Swine Lagoon Liq.
PH DM (40) SS (10-55/cm)
EC (mS/cm)
CC (%) ALE(1000 gal.) C:N
Inorganic N
NH4-N 7.20
Comments:
NO3-N
Organic N Ni (ppm) Cd (ppm) Pb (ppm) Al (ppm)
Se (ppm) Li (ppm) As
(ppm) Cr (ppm) CO (ppm) Cl (ppm) MO (ppm)
Urea
Estimate of Nutrients Available for First Crop (lb 1 1000 gal.)
Other Elements (ib 1 1000 gal.)
Application Method
N P205 K20 Ca Mg S Fe Mn Zn
CU B Mo
Cl Na Ni Cd Pb At Se Li
Irrigation
0.68 0.83 2.51 0.35 .0.23 0.07 0.01 T T
T T
0.52
Agronomist's Comments:
Aaron Pettit 2/12/2015 4:03 PM
North Carolina
It[%i(d . IrLAt VIIfUl k: WItu;aN1n
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you far using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Trailer, Commissioner of Agriculture.

r,,
N
II. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YR./24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1. Structure ID: Main Hole
line m =
89.6 lb PAN
2. Structure ID:
line m =
lb PAN
3. Structure ID:
line m =
lb PAN
4. Structure ID:
line m =
lb PAN
5. Structure ID:
line m =
lb PAN
6. Structure ID:
line m =
lb PAN
n.lines 1+2+3+4+5+6= 89.6lbPAN
III. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAY DRAW DOWN
PERIOD. DO NOT LIST FIELDS TO WHICH PAN
CANNOT BE
APPLIED DURING THIS 30
DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s. remaining ERR
2 PAN balance
(lb/acre)
t TOTAL PAN
BALANCE FOR
FIELD jibs.)
column r: s
u. application window'
5368
1
Bermuda Pasture
10.50
230.00
2415.0
March -Oct.
v. Total PAN
available for all Melds
(sum of column t) = 2415.0 lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (line n from section II) = 89.6 lb. PAN
x. Crop's remaining PAN balance (line v from section III) = 2415.0 lb. PAN
y. Overall PAN balance (w - x) = -2325 lb. PAN
Line y must show as a deficit. If line y does not show as a deficit, list course of action here including pump and
haul, depopulation, herd reduction, etc. For pump & haul and herd reduction options, recalculate new PAN
based on new information_ If new fields are to be included as an option for lowering lagoon level, add these
fields to the PAN balance table and recalculate the overall PAN balance. If animal waste is to be hauled to

another permitted facility, provide information regarding the herd population and lagoon freeboard levels at the
receiving facility.
Make sure fields are dry enough to receive waste application.

NCDA&CS Agronomic Division Phone: [phone] Webeite: www.ncagr.gov/agronomi/
FY15-W004587
Il�rl'41..i
41
Predictive
Client: Ernest Smith Farms
Advisor:
PO Box 741
y R
r
Waste Report
Garland, NC 28441
.
Bladen County
hN tfit%'%
Sampled: Received: 02/05/2015
Completed: 02/16/2015
Farm:
Links to,Helpful information
Sample Information
Nutrient and Other Measurements
Nitrogen (N) (ppm) P (ppm)
K (ppm) Ca (ppm) M.q (ppm)
S (ppm) Fe (ppm) Mn (ppm)
Zn (ppm) Cu (ppm) B (ppm) No (ppm) C (ppm)
Sample ID: NJACK
Total N 43.5
251 41.6 28.0
8.87 0,79 0.21
0.24 0.32 0,21 62.5
Waste Code: ALS
Description:
Total Kleldahl N 163----------------------------
-------------------------------------------
--
------------------------------------ ------
Swine Lagoon Liq,
inorganic N pH
DM (%) SS (10-5SICm)
EC (mS/cm)
cc (%) ALE(1000 gal.) C:N
NH4-N 7.20
Comments:
NOs-N
Organic N NI (ppm)
Cd (ppm) Pb (ppm) Al (ppm)
Se (ppm) Li (ppm) As
(ppm) Cr (ppm) Co (ppm) Cl (ppm) Mo (ppm)
Urea
Estimate of Nutrients Avallabte for First Crop (lb 11000 gal.)
Other Elements (ib 11000 gal.)
Application Method
N P2O5 K2O Ca Mg
S Fe Mn Zn
CU B Mo
CI Na Ni Cd Pb Al Se Li
irrigation
0.68 0.83 2.51 0.35 0.23
0.07 0.01 T T
T T
0.52
Agronomist's Comments:
Aaron Pettit 2/1212015 4:03 PM
North Carolina
Ird+;rci'Ir TILI%t Fulxl CIHNuelk %100
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission. .
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Traxler, Commissioner ofAgriculture.

t
rnspecnon
lReason for Visit:
O Follow-up O Referral O
r:vaivanon
Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: D County: Region:
Farm Name: jef �/�C Ge�r►�- Owner Email:
Owner Name: -e ; I ( Phone:
Mailing Address:
Physical Address:
Facility Contact: 1Jr j 11 eG �S�'*-�— Title: 1,94lUH Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator: �rr,�����'"'��'1✓Qjj��
Certification Number: /6
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Gattie Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder
-�-1
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Dairy Heifer
Dry Cow
D . l;ouI Ca aci P,o _. Non -Dairy
La ers Beef Stocker
on -Layers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ig 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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 21412014 Continued

Facili Number: - v Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZI 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): �O
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 B No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
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? 0--Yes ❑ 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 Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes g 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 CropWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
."
12. Crop TYpe(s): A= 'f'///!�i/rrS
13. Soil Type(s): N Q,A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z 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
[DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ 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 Dq No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - j 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 (2 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 f,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
C . No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question.#) Eaplain`any YES answers_and/or anyiadditionallr-commendations or any other cob-iin6 ts. �MI
rr
_ •••___ ___
Q/r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2%52l9��xn)o
Date:
VW 0I4

4L
• .v_ision of Water Quality l
Facility Number 1 7 111 ater Conservation
Other Agency
Type of Visit: QMompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint I{'ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / .'pry Departure Time: County: ��-----
Farm Name: /l%C; /�G�C519 '�r� Owner Email:
Owner Name: / v - F t! Phone:
Mailing Address:
Physical Address:
Region: Q
Facility Contact: Title: 90,.yj e Phone:
Onsite Representative: ��.t.t� Integrator: �or•rL ��''"`�
Certified Operator: Certification Number: lk�ell
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swrne Capacity Pop. W,et Poultry Capacity Pop.
Cattle C•apaeity Pop.
Wean to Finish La er
Dai Cow
an to Feeder
3
Non -La er
Dai Calf
eeder to Finish
&
—d— - - -
DairyHeifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr P,oult Ca aci P,o P.
Non -Dairy
Farrow to Finish
Layers
I Beef Stocker
Gilts
I
INon-Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
- -
Turkeys
Other _
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
(g NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - pe2 Date of Inspection:
Waste Collection & Treatment
" 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U�No
❑ NA
gNE
a. If yes, is waste level into the structural freeboard?
[:]Yes
[:]No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
[Z 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
ONE
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
ES�NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
aNE
(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
R3 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EZ No
❑ NA
®, NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Et 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 ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWNW readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - / Date of Inspection: : /
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 ® 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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [�] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[] No
❑ NA -Q 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
E6 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Z No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z 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 #r): 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).
��'dl 7� �� 7`T !�''S; f i � f�c' �-ne�►��13/ �v Il� tl� of �',�j �r-�e�Y'� �rT�-�j
,5r-G0,.t/1� O-) ---, —P 6- t4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: Da
Date:
21412011
Page 3 of 3

N0p- (FC- (2--b361
(Type of Visit: ('Compliance Inspection V Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: outine O Complaint Q Follow-up O Referral p Emergency O Other p Denied Access
Date of Visit: Arrival Time: 3 Departure Time: ,' O� County: ".—
Farm Name: �%� i r5 $�-._. tGa gym— Owner Email:
Owner Name: '1j r_ i t T;; Phone:
Mailing Address:
Physical Address:
Facility Contact: N'e I Za74A Title: �y� �r - Phone:
Onsite Representative: � f_ek
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: Z� Q
Integrator:
Certification Number: /61
Certification Number:
Longitude:
Design Current
DesigD
Cnrrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle• Capacity Pap.
Wean to Finish
Layer
Daity Cow
Wean to Feeder
p D
Non -La er
I
I
Dairy Calf
Feeder to Finish
OC7
. `=-;_
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . _ P<..pul
Ca aei
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
„
Qther
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[ +RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
/ �2__
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure S
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)-
S. 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?
ayes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CaNo
❑ 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
[0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _Arn /_m�a �a
13. Soil Type(s): off"
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ 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 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[. No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ELNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
MNo
❑ 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 ER No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21417011 Continued

t
Facility Number: - Date of inspection: 'P- —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes m No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[-]Yes Ej No ❑ NA ❑ NE
❑ Yes (3 No ❑ NA ❑ NE
❑ Yes Na No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes
is No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Eallo
❑ 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)..::
" _L
P%l"lar-r-, +f1u'3.
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: Date: /,,;?— 7 �fl/mZ
Page 3 of 3 21412011

H
Type of Visit: lDfifpliance 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: ; ,3 a Departure Time: ; Q[7 County: r,.._
Farm Name: � - �, Owner Email:
Owner Name: jfJ f / t lck a -., _ Phone:
Mailing Address:
Physical Address:
Facility Contact: r�'�/ 6e_kSV__ Title: �y �- Phone:
Region: /Zz
Onsite Representative: 5;GrR.a Integrator:
Certified Operator: , j'�F-e.� Certification Number: A,
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Non -Layer
ig Cow
Dairy Calf
Wean to Feeder
Da
Dairy Heifer
Feeder to Finish
(Q p 42,90
Farrow to Wean
pe"sign
Current
D Cow
Farrow to Feeder
D 1?ouIt , Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turke s
Turke Faults
FE60"er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes g No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
®. No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili y Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): .19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[O No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes M No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
01 Yes
❑ No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Co 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
❑ 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
[0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FA 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 M. No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections OM onth ly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jallo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: JDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [SNo ❑ NA ❑ NE
a 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
• the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes C' No ❑ NA ❑ NE
❑Yes MNo ❑NA ❑NE
❑ Yes E] No ❑ NA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes [X No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[—]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments: refer to uestion . Ex 1 " ' ( q #iry• pain any:YES answers`and/ar any additional: recornmen d;;itions or;any o#tier Caroments"�� ��"?7i
Use drawings of facility to better explain situations (use additional pages as necessary).
Lv®.--,�ys�-� Lon A^.,��, ) Pub;
O
Reviewer/inspector Name:
Reviewer/inspector Signature:
Phone:Q-�33D¢
Date:
21412011
Page 3 of 3

4
Type of Visit &<bmpliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: G / Arrival Time: Dv Departure Time: �.' County: �w e� w Region: ID
Farm Name: Pe ' �tC SAS L//✓mom Owner Email:
Owner Name: /�� i P Phone:
Mailing Address:
Physical Address:
Facility Contact: ,/�!�'i`/I Title://i��r.n✓ = _ Phone No:
Onsite Representative: f_ Integrator:l'-r,:�✓+�
Certified Operator: J'�^ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' 0 « Longitude: = ° = ' 0
Design Current
Design Current
Design C►urrent
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Da' Cow
❑ Dairy Calf
Dairy Heifer
❑ Wean to Finish ❑ Layer
Wean to Feeder
O ❑ Non -Layer
Feeder to Finish
I 4,vo4❑
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
ElBeef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars ❑ Pullets
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes [KNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JK No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E[No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3 12128104 Continued

n
Facility Number: — Q 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?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
r
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R 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 RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ja 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 [3 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 J0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs '❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) ft le
13.
Soil type(s) Jl%pe!�
14.
Do the receiving crops differ from those desigmated in the CAWMP?
❑ Yes
Qf No
❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement?
0 Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes
,9L No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ESNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question #,): EY xplain any ES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ilAul n3��� aLvafn dask�5 C Apr
NasaL S �C'L���•-- 5� F/�m �
1lrv- iA �a iti� 1Jaccl
.ram o �iaeK- i+�-
Reviewer/inspector Name/�y, (��� �l—^ Phone:
Reviewer/Inspector Signature: Dater
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
i
K,20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ®No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis U Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(gNo
❑ NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
59 Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
IN No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ 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
0 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
ENo
❑ 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
Eallo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
r '4'e"c b1_v6ke) ceeddl 6w'.0r�,l ouj o", Aous-
Q 7,—,l w,,A 6 o,"
Y
Page 3 of 3 12128104

U
Type of Visit (gKompliance Inspection O Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit GHTo'utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: c'i Departure Time: County: ffkRegion: - v
Farm Name: jje_—_%lam[ 2! 5 8'"— Owner Email:
Owner Name: _t!—' i l �Gt �i�C _sue �— Phone:
Mailing Address:
Physical Address
Facility Contact: 1`-' r I I CZ0 K Cr— Title: V)U-)A 4 Y— /Phone
��No:
Onsite Representative: Integrator: �'-�s✓h.�/Ta/'+n�
Certified Operator: sue— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = r 0 u Longitude: = ° 0 4 = 1i
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
C►attle Capacity
Population
❑ Wean to Finish
I 1[j Layer
❑ Dairy Cow
® Wean to Feeder L
—o—
❑Non -La Non -Layer
❑ Dairy Calf
Feeder to Finish
.301)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El
El Farrow to Finish
ElLayers
❑ Beef Stocker
❑ Gilts
ay
ElNets. ers
El Beef Feeder
❑ Boars
El Pullets.
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
[a 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 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
2 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — 0 Date of Inspection LJ'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QjNo ❑ NA ❑ NE
the appropirate 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
29 No
❑ NA
❑ NE
❑ Yes
,I No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
RI No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
(LNo
❑ NA
❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes ZLNo ❑ NA ❑ NE
Additional Comments and/ror Drawings:
Page 3 of 3 12128104

z Facility Number: — �p
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?
Structure I
Identifier:
Structure 2 Structure 3 Structure 4
❑ Yes No ❑ NA ❑ NE
El Yes No ❑NA [I NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): _ 9
Observed Freeboard (in):�=
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�9 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
[3 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
MNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [0 No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or to lbs ❑ Total Phosphor -us ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
�of Wind Drifl ElApplication Outside of Area
12. Crop type(s) 4Cy, w 1 f M&A
13. Soil typc(s) I U la A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 10 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ULYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[2 No
❑ NA
❑ NE
18. is there a,lack of properly operating waste application equipment? ❑ Yes
54No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
C71f-p,tl- d0d1pe.rr3
pGw_r lV41)eL dvwi% d V r -I
W
Reviewer/ins ector Name
P Phone: 0'f.'33 —':33C�Iz-
Reviewer/Inspector Signature: Date: )9
19/94/B,f !'nnfiaand

D�
Type of Visit Q�e—ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &X66utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: O % O Ci County: ►L Region:
Farm Name: /f& II �Sa �Crrm,� Owner Email:
Owner Name: Z-3 Phone:
Mailing Address:
Physical Address: Facility Contact: IV 01 EET C IY� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ 4 = « Longitude: ❑ o ❑ , = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Design Current
C•al#le Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
0 ❑ Non -Layer
❑ Daiia Calf
Feeder to Finish
D
El Dairy Heifer
❑ Farrow to Wean
Jp�. Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
ElFarrow to Finish
El Layers
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars.
❑ Pullets
❑Beef Srood Cowl
- -u El Turkeys
Other
r ❑ Turkey Puults
❑ Other
❑ Other
NNamr of Structures:
Discharges & Stream Impacts
1- is any discharge observed from any pan of the operation?
❑ Yes
K 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 discharge bypass the waste management system? (Ifyes, notify DWQ)
❑ Yes
❑No
❑NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
®No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5Z No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Confinued

Date of Inspection O
Facility Number:
l Waste Collection & Treatment
'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CRNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tR No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[N No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
& Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JO 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
EN No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No [I NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
02 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) __kV -" _. -��f _
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
X3 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
[9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
O�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or anvrecommendations or any other comments
Use drawings -of facility to better explain situations. (use addthonal pages as necessary):
1'?1ar1f_ AL
Reviewer// nspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 5 12128104 Continued

Facility Number: 9-lo,4 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
W No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JO No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El 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
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
I}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
R No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JZ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
N No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Page 3 of 3 12128104

sion of Water Quality 13
Facility Number En U 1] 0 Division of Soil and Water Conservation j _ , `��
- 0 Other Agency (o G�
Type of Visit ar' ommppiiance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 046utine 0 Complaint 0 Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ry Arrival Time: Departure Time: r County: X Lg rry Region: jEjM
Farm Name: A , Owner Email:
Owner Name: - N,-Phone:
Mailing Address:
Physical Address: )�
Facility Contact: N e j- �Ct ! it.S` of Title:
Onsite Representative: �.-•�-�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
L l Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
PhoneNo:
Integrator: &-/1--.1 -22= 5...-
Operator Certification Number: / w n�
Back-up Certification Number:
Latitude: 0 0 = i Longitude: = ° ='
=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ❑ La er
lad 122 A2 I ❑ Nan -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
E]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?
❑ Yes 5] No ❑ NA ❑ NE
❑ Yes
❑ No *,❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

ME
Facility Number: —
Date of Inspection '-- - —
Waste Collection & Treatment
4. is storage capacity (structural plus stone 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:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® 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? 1a' Yes ❑ No ❑ NA ElNE
& Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V 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/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)ZT
13.
Soil type(s) Aloit
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
W No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
§4 No
❑ NA ❑ NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0 No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
J@ No
❑ NA ❑ NE
1$.
Is there a lack of properly operating waste application equipment? ❑ Yes
Na No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
le n
Reviewer/inspector Name G Phone: ?VV-t133 ; T3VD
Reviewer/Inspector Signature: Date: 3 -3 17
IL/Law4 uonunuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EA No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes S 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
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
$?No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ 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
f0 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
19 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ERNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
64 No
❑ NA
❑ NE
Additional Comments andlor Drawings:
AL
r
12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit @-Ifo—outine O complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Arrival Time:
- iTt� Departure Time: I // County: r Region:
Farm Name: Al,!--; I I �C� s� G►.M't� Owner Email:
J .
Owner Name: A e ! Zff 5_w_� Sf? ^-tePhone:
r
Mailing Address: l t04 (0 JFLWC-11 _. Fe'trj f%^ en u-n r34
Physical Address:
Facility Contact:
Title:
Onsite Representative:�c
Certified Operator: Sy -
Back-up Operator:
Phone No:
Integrator: �If
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: = ° = I = u
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle C►apacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
tZ Wean to Feeder
t7
17 fl
Non -Layer
I
I I
❑ Dairy Calf
Feeder to Finish I
dijEl
Co 00
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ N ers
El Beef Feeder
❑ Boars
❑ Nets
Pullets
❑ Beef Brood Cowl
❑ Turkeys
—
Other
❑ TurkeyPonits
❑ Other
❑ Other
Number of 5truetures:
Dischary_" & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ 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
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Cf — p Date of Inspection b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JA No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
19 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?
t[ 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)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
MNo El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'IffNo ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside
of Area
12. Croptype(s) ,VPP44)11, /�Urr�ie+t
l=
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
JO No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
10 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�4 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Comments (refer to question #): 'E%plain., any,YES. answers; and/or any:recommendations.or any other comments . :r
Use drawuigs of facility to better explain situations..(use;additional pages as necessary):
C10-Ac 7—o 4 /v e- dK
lurul
Reviewer/Inspector Name F Phone: Do-0.3-33ac,
Reviewer/Inspector Signature: Date: a— O
Page 2 of 12/2VO4 Continued

Facility Number: — Date of InspectionD �o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No ❑ NA ❑ NE
20. Does the facility fail to�have all components of the CAWMP readily available? If yes, check ❑ Yes $i No ❑ NA ❑ NE
the appropriate box.
El WUP ❑ Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes [:]No ❑ NA ❑ NE
❑ Waste Application A Weekly Freeboard ❑ Waste Analysis C5SMAnalysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
to No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fo No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EN No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
CR No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Page 3 of 3 12128104

y
i�ision of Water Quality
Facility Number u D� Division of Soil and Water Conservation '
Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
O Routine O Complaint
O Follow up O Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: /Y]ra County: r' Region: C�
Farm Name: o Fa r myL Owner Email: 1
Owner Name: 'Al _ i i _ a S b Phone: 220 I
Mailing Address:
Physical Address:_ -
Facility Contact: Title:
Onsite Representative:
Certified Operator: s,z- W T_-
Sack -up Operator:
Location of Farm:
Phone No:
Integrator: ?I
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ I = ,. Longitude: ❑ ° = 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population .
❑
Wean to Finish
IWean
to Feeder
.Q 04
1dp
[9
Freeder to Finish
[>p
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other -- - — - -
❑ La er
3 �
❑ Non-Layet
i Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current .',.
Cattle Capacity Population:.
❑ DairyCow
ElDai Calf
❑ DairyHeifei
❑ D Cow
❑ Non-Dai
El Beef Stocker
El Beef Feeder
❑B dC
Beefroo 0
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes VQ No ❑ NA ❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
O(No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
0 No
❑ Yes
54 No
❑ NA
❑ NE
❑ Yes
xNo
❑ NA
❑ NE
12128104 Continued

Facility Number:- /fj Date of Inspection Imo-
.
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 RNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _!g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(Z 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?
5q 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
[KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
R,No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
51 No
❑ NA ❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
14 No
❑ NA ❑ NE
li'tow �h c i M S ►` �� o ��Ct� �a w- v�- .a,rour�r o� tf`�s�
Reviewer/InspectorName Guy: i.- Phone:
Reviewer/Inspector Signature: Date: D — 'D
12128104 Continued

Facility number: — Date of inspection D-- -0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes JgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E.No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EKNo
❑ NA
❑ NE
23.
If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
❑ No
IS�NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30_
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
J&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CK No
❑ NA
❑ NE
Additional Coinruents and/dr Drawings
12128104

(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of visit: !l' ��'8 Time: ' OD
Facility Number
57—otoperationaii Q Below Threshold
Etf'ermitted [yCertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: . IV
1! Jae.k.,,, County: a9ien-F�Po--
Owner Name: Nc,� Saul o Phone No:rl/O- G L r!' '1 a Y
11�Iailing Address: --!& At& S F./.br9LL.....FCr9G.,.... Road � .,G�.�.c l AL ...21.!u y .
Facility Contact: ... lVe d Mr. -K Title: Phone No:
Ousite Representative: N . .jar l/_sa., Integrator: lra rin �sl F ,� Sr y4�
Certified Operator: 9 . % ^ �� � be - . Operator Certification Number: ! ( 2IV tr
Location of Farm:
a6wine ❑ Pouttry ❑ Cattle ❑ Horse Latitude 0' ` " Longitude •
bwme CCpadWsp4
o Feeder
to Finish
to Wean
to Feeder
l
to Finish
r
Mes'egn-'Cnrrent Current
=Y- x Capact9 �PopuLstiaFa, Cattle ` Capscq;' popWatRon
�} Total Design Ca�acl<ty'
-T
GW'SSLW.
Discharges & Stream I
1. Is any discharge observed from any part of the operation? ❑ Yes �To
Discharge originated a : ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'? ❑ Yes ff90
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes M-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 allo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes BWo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes D No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _..._—L... .. _ __.----
Freeboard (inches): 3t
rr
12112103 Continued

Facility Number: q —
Date of inspection I // -.2
5. Are there any immediate threats to the integrity of any of the structures observed? (id 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 DWt)
7. Do any of the structures need maintenaneetimprovement?
8. Does any part of the waste management system other than waste structures require maintenanoe/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ARWication
10. Are there any buffers that need maintenancehmprovement?
❑ Yes PNO
❑ Yes [?No
❑ Yes a 1Qo
❑ Yes 01�0
❑ Yes QNo
❑ Yes B No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes afgo
Crop type
�❑ PAN (❑ Hydraulic
Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop `1 X" LJ�iM UII J/h 12-// COY d. Jti
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAV;W)? ❑ Yes ENO
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?
l5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0N0
❑ Yes M-No
❑ Yes ❑ No
❑ Yes 0'�0
❑ Yes ['io
❑ Yes 0,90
❑ Final Notes
r ..i � � w s; -E-e �..r = } 4r^a X .s' -L� ="Uqx FPS
Reviewerlla5pectorName� _ `� Reviewer/InspectorSignature: Date: f -tea a
12112103 Continued

Facility Number: 9 —10.2 1 Date of inspection
Reouire-d Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/, chu, / - , 7K etc.)
[I Yes
[•]-No
23. Does record keeping need improvement? If yes, Check the appropriate box below.
❑ Yes
61W
❑ Waste 1❑xwobeaf& ❑ est sis ❑fie-l"Sa r-5
10-Is-7.s7r.y-�a->
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EWo"
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[u*T
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
,., ,,�
(ic/ discharge, freeboard problems, over application)
B7rio
27. Did ReviewerA speetor fail to discuss reviewlinspection with on -site representative?
❑ Yes
UN6-
28. Does facility require a follow-up visit by same agency?
❑ Yes
MW6
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
mwo-
NPDFS Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes M4go
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112fO3

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: 1Z- 32
Farm Name/Owner:j Z_ J1 2!_�,rcZ-11,1b IA
Mailing Address: _�5 .3
County:___
Integrator:
On Site Representative:
Physical Address/Location: /8
1��e 'Sq
)HU. 7-ly 2 4 - ;7,Cc�i
Phone:_ f /o - � ( i - 2/Z _'*'
All
Type of Operation: Swine L Poultry Cattle l .��sgz s P7 4 7;
Design Capacity: / s 7J Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inchest�r No Actual Freeboard:I Z Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes o�
Is adequate land available for spray?? Yes or No Is the cover crop adequate? Yes orS
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. r No
100 Feet from Wells? z�r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oZ
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue`` --jinn Yes No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate w management records (volumes of manure, land applied,
spray irrigated on specifi acreage with co er crop)? Yes or No
Additional Comments:
6:�/2z ✓fir -7-70-7-
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

f
1
r
\ j
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Z ww � `i