090128_INSPECTIONS_20171231

MDivision of Water Resources
Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 090128 Facility Status: Actve
Permit: AWS090128
❑ Denied Access
Inpsection Type: Compliance Inspection
Inactve Or Closed Date:
Reason far Visit Routine County:
Bladen Region:
Fayetteville
Data of Visit: 09120/2017 EntryTima: 08:15 am Exit Time: 9:00 am Incident #
Farm Name, Peters Creek Farm (Sow)
Owner Email:
Owner. Baz Inc
Phone:
910-285-1005
Mailing Address: PO Box 1139
Wallace NC 284661139
Physical Address: 329 County Line Rd
Clinton NC 2832E
Facility Status: Compliant ❑ Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm: Latitude:
34° 50' 11" Longitude:
78° 30' 2W
SR 1528 to NC 210 and go 6.5 miles and turn left on SR 1501 at BladerdCumberland county line, go 0.3 miles on SR 1501 to
farm on left. Farm # 2453.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other issues
Certified Operator: Douglas Stephan Atkins Operator Certification Number: 985736
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Doug Atkins Phone
On -site representative Doug Atkins Phone
Primary Inspector. Bill Dunlap
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Calibration 05-15-2017
Sludge Survey N-6.4, 0-0.2 97% Before sludge removal??
Pulls #01, 01 a, 01 b, 02, 02a, 3, 4 need a ton or more of lime.
Phone:
Date:
page: 1

Permit: AWS090128 Owner - Facility : BazInc Facility Number. 090128
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Swine
Design Capacity Current promotions
Swine - Farrow to Wean
3,600
3,600
Swine - Feeder to Finish
1,000
1,000
Swine - Wean to Feeder
400
400
Total Design Capacity: 5,000
Total SSLW: 1,705,800
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.50 42.00
page: 2

Permit: AWS090128 Owner - Facility: Baz Inc
Facility Number: 090128
inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Dischames & Stream Impacts
Yes No Na Me
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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)
❑
M ❑
❑
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 Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Stora-ge & Tregtment
Yes
No Na Me
4. Is storage capacity less than adequate?
❑rM❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (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
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

4
Permit: AWS090128 Owner - Facility: Baz Inc Facility Number. 090128
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Aoolication Yes No Na N9
Crop Type 1 Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2 Coastal Bermuda Grass wr
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Wagram
Soil Type 2
Norfolk
Soil Type 3
Goldsboro
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
E ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
[]
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
■ ❑
❑
18. Is there a lack of properly operating waste application equipment?
[]
0 ❑
❑
Records and Documents
Yes No Na No
19, Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E[]
❑
20. Does the facility fail to have ail components of the CAWMP readily available?
❑
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
E ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

Permit: AWS090128 Owner - Facility : BazInc
Facility Number. 09012E
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
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?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes
No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32, Were any additional problems noted which cause non-complianoe of the Permit or ❑ 0 ❑ ❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ M ❑ ❑
page: 5

type of visit: U7Routine
fiance inspection V Vperanon Review V atructure Evaluation U I echmcal Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' Departure Time: County:?LkAL
Farm Name: PCb�sS Ceee `- Sai.J Fayn Owner Email:
Owner Name: jA 42 rv, G Phone:
Mailing Address:
Physical Address:
Region:
FRf/
Facility Contact: aJ A% Title: Phone: ec
Onsite Representative: !( Integrator: ly 13! J
Certified Operator: .,� Certification Number: g'S 3g
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design, Current
Design Current
Swine Capacity Pop.
Wet Poultry Cap_ city "Pop.
Cattle„ Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish (p
-.
Dairy Heifer
Farrow to Wean t7/
Design'.:.
Current
D Cow
Dry P,oultr.
Ca acP,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood cow
Otber
Turkeys
TurkeyPoults
—
+;
Other
�
a` -
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)?
❑ Yes Rio [:]NA ❑ NE
❑ Yes
❑ No
C?-NA
❑ NE
❑ Yes
❑ No
E�JIVA
❑ NE
d. Does the discharge bypass the waste management system? (If ves, 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
[' NA
❑ NE
❑Yes
[ o
❑NA
❑NE
❑ Yes
ff No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

ftFacili umber: q- Date of Inspection: , .� a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EEMA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `f L4
5. Are there any immediate threats to the integrity of any of the structures observed? [-]Yes dNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ 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 dNo ❑ 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 ❑DApplication Outside of Approved Area
12. Crop Type(s): 43dsy �j., !g U� f:L
13. Soil Type(s): i 0%
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [%rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�f_No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (3-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [:]Yes dNo ❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment? [:]Yes [fNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes C]rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [/"No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ffNo
❑ 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 eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ffNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Dumber: - e Date of Inspection: t? ' C
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�J ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E3 <o ❑ 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 D<O ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ea<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Eg-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
Ala ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
/
❑VIVO ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
EKo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FZ/No ❑ NA
❑ NE
Comments r fe q �hon #}: Explain an"y 1'ES answers and/or a y ad' any other carniFents.
'� { i.. � ty gp { P g ditronalzre�mmendatrans ar �� � �� ° ,q
Use�drawings�of fact. �to�tletter a Earn situataons nse addttronalF a es'ras,ne'cessa, �). , -,:,
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 3— 333 I
Date: (} U
21412015

R / W-C
-1
EL
1 t ype of visit: .rdcompuance Inspection U uperanon Keview U structure Evaluation U I ethnical Assistance
Reason for Visit: i�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a Arrival Time: Departure Time: County:
Farm Name: PiA�V`G� h Owner Email:
Owner Name: GAZ Phone:
Mailing Address:
Physical Address:
Facility Contact: W$ J 1 T fe I V\.,f Title: Phone:
Onsite Representative: 1 Integrator: [�
Certified Operator:
Back-up Operator:
Region:t�^
Certification Number: I 0 � l
7 r
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Curren_ t
Capacity Pop. Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder y
4 t7
Non -La er
Design Current
Ca aci Po
Calf
Feeder to Finish QOU
Farrow to Wean
Farrow to Feeder
j DOO
q7
Dry Point .
DairyHeifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
�'
1. Is any discharge observed from any part of the operation?
❑ Yes
3-5N0
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�TA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
�A
❑ 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
[2,<o
E34A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E 0INo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate of inspection: a t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes G=t1`s ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.) -
❑ Yes �o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
B-ivo
❑ 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
E�,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E3"�4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
0 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): (3
'5 (0 0
13. Soil Type(s): fV0 U
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes e No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes [7"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes - ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [:]Yes io ❑ 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 [Z?�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes E(No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes E j o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes e o ❑ NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes PNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - oZ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R2�� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ 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 ffNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [f 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)
❑ Yes [3Vo ❑ NA ❑ NE
❑ Yes [] N ❑ NA ❑ NE
[—]Yes D<0 ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes LerNo
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 'No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [21�o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E3Xo
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer. to -question # ): Explain any YES answers and/or, any additional recommendations.or any�other,commea#s�
Use drawings of facility to better explain .situations (use additions! pages as necessary).
Reviewer/Inspector Name: Phone: 3
Reviewer/Inspector Signature: Date: Po
Page 3 of 3 1 21412014

I ype of visa: L44compliance Inspection V operation Review U structure Evaluation U 'l echnical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: "County: F4Region:
Farm Name: a./`s CV_ Owner Email:
Owner Name: ) NCB Phone:
Mailing Address:
Physical Address:
Facility Contact: 04!j �Ik�s Title:
Cr
Onsite Representative: 1
Phone:
Integrator: A4
Certified Operator: 1 t Certification Number: 115 73 F_
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
' o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[l' VA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
j"" "
0 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
E NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Ins ection: ,K,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [fA ❑ 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
qo
❑ 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
[� o
❑ 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
E] l o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
c, o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I]"4o ❑ NA
❑ 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 [3 Application Outside of Approved Area
12. Crop Type(s): er h SG 'Q
13. Soil Type(s): C 'D
14. Do the receiving crops differ4om those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
ED bK
❑ Yes
Qxo'
❑ Yes
D-No
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]Yes [fKo ❑ NA ❑ NE
❑ Yes E��o❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
io
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D1' o_
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E]- o
❑ 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 g[44o ❑ NA ❑ NE
Page 2 of 3 214/2014 Continued

Facili• Number: J270- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6-<O 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 [-Iqo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes LL!"1fo ❑ NA ❑ NE
Other Issues �'�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes LLJXo ❑ NA 0 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?
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 Signature:
❑ Yes No ❑ NA ❑ NE.
❑ Yes Io ❑ NA ❑ NE
[:]Yes E5<o ❑ NA ❑ NE
[—]Yes VVO
❑ Yes ❑YesWo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 3 of 3
21412014

DENR-FRCS
12
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Othet , Q Denied Access
5 1
Date of Visit: J O d Arrival Time: Departure Time: unty: Region:
t
Farm Name: .� �� p ' - �wne.r Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: at h �
Certified Operator: hhLI)n
Back-up Operator:
Location of Farm:
Wean to Finish La er
Wean to Feeder Non-L.
Feeder to Finish
Farrow to Wean.
Farrow to Feeder D , Pic
Farrow to Finish LaEerGilts No
Boars Pullets
Other I 1 11 (Other
Phone:
Integrator:ft D D YIILy;r)
Certification Number:
Certification Number:
Latitude: Longitude:
Poults
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?
Dairy Cow
Dair
y Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes FOOD
NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes NA ❑ NE
Page I of 3 21412011 Continued

f
'J FaciliNumber: - Date of inspection: /Q
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
2o ❑ NA ❑ NE
�No ❑ NA ❑ NE
Structur. . 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No 0 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 environment t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesVNoo
NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 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
PXd DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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?
J
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
r.Ng,,'
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Ycs❑
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
th r riate box
e app ap
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: 01 - Date of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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 ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 A
❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesrN00
NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesNA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ YesNA
❑ NE
omments (refer to,gdestion ft Explain any YES answers and/or any addi
;!'drawings of facility! . better explarn situations (use additional pages as
cf�gp Li fIf Id V wtzk ikvr
Soi .� �Ps-�-- r1/2-7/ice,
ou� crBgA„h
z 9�T-
An
S`1;2 y / l 3
5/3/13
3120113
2 l�z�ll r3
Reviewer/Inspector Name:
or:any other;commen•
Phone
Reviewer/Inspector Signature: Date
Page 3 of 3
I
2141'2011

0 Division of Water Quality
Q Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 090128 Facility Status: Active Permit: AWS090128 ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Routine County: Bladen _ Region: Fayetteville
Date of Visit: 10/1W2013 Entry Time: 10:30 AM Exit Time: 11:99 61A Incident #:
Farm Name: w Owner Email:
Owner: Baz Inc Phone: 91Q;285-100,12--
Mailing Address: PO Box 1139 }Wallace NC 284661139
Physical Address: 329 County Line Rd Clinton NC 28328
Facility Status: 0 Compliant ❑ Not Compliant Integrator: M irp'hy-Brown LLC
Location of Farm: Latitude: 34'50'11" Longitude: 78°30'28"
SR 1528 to NC 210 and go 6.5 mites and turn left on SR 1501 at Bladen/Cumberland county line, go 0.3 miles on SR 1501 to farm on
left. Farm # 2453.
Question Areas:
Dischrge & Stream impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Douglas Stephan Atkins
Secondary OIC(s):
Operator Certification Number: 985738
On -Site Representative(s): Name Title Phone
24 hour contact name Doug Atkins Phone:
On -site representative Doug Atkins Phone:
Primary Inspector: Ronnie T Smith Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Page: 1

Permit: AW5090128 Owner - Facility: Baz Inc Facility Number: 090128
Inspection Date: 10/10/2013 Inspection Type: Compliance inspection Reason for Visit: Routine
Inspection Summary:
crop yield records reviewed
Soil test 11/27/12
—due again 2015—
L=OT
Cu & Zn levels wlin range
Waste Analysis N
816/13 = 1.14
6/14/13 = 1.10
5/24113 = 2.15
513113 = 1.55
3/20/13 = 1.67
2121/13 = 1.18
1/22/13 = 1.85
irrigation records correspond to rainfall & lagoon records
"Sludge Survey due 2013""
clean out 12/19/12 42%
—irrigation calibration due 2013—
lagoon banks good vegetation.
Page: 2

Permit: AWS090128 Owner - Facility: Baz Inc Facility Number: 090128
Inspection Date: 1011012013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Swine
Swine - Farrow to Wean
3,600
3,600
Swine - Feeder to Finish
1,000
1.000
Swine - Wean to Feeder
400
400
Total Design Capacity: 5,000
Total SSLW: 1,705,800
Waste Structures
Designed Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
lagoon 1 19.50 52.00
Page: 3

Permit: AWS09D128 Owner - Facility: Baz tnc Facility Number : 090128
Inspection Date: 10/10/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yes No NA NE
1. Is any discharge observed from any part of the operation? ❑ ■ ❑ ❑
Discharge originated at:
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ ■ ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ ■ ❑ ❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) ❑ ■ ❑ ❑
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 Waters of the State other than ❑ ■ ❑ ❑
from a discharge?
Waste Collection, Storage & Treatment Yes No NA NE
4. Is storage capacity less than adequate? ❑ ■ ❑ ❑
If yes, is waste level into structural freeboard? ❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./large trees, severe ❑ ■ ❑ ❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑ ■ ❑ ❑
or closure plan?
7. Do any of the structures need maintenance or improvement? ❑ ■ ❑ ❑
8. Do any of the structures lack adequate markers as required by the permit? (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 maintenance or
❑ ■
❑
❑
improvement?
Waste Application
Yes No
NA
NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
11000
improvement?
11. Is there evidence of incorrect application?
❑ ■
❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overioad?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
Page: 4

Permit. AWS09D128 Owner -Facility: Baz Inc
Facility Number: 090128
Inspection Date: 10/10/2013 inspection Type: Compliance Inspection
Reason for Visit: Routine
Waste Application
Yes No NA NE
PAN?
❑
Is PAIN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Records and Documents
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available?
If yes, check the appropriate box below.
W UP?
❑ ■ ❑ ❑
❑ ■ ❑ ❑
❑ ■ ❑ ❑
U
Page: 5

Permit: AWS090128 Owner - Facility: Baz Inc Facility Number. 090128
Inspection Date: 10110/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No NA NE
Checklists? ❑
Design? ❑
Maps? ❑
Lease Agreements? ❑
Other? ❑
If Other, please specify
21. Does record keeping need improvement?
If yes, check the appropriate box below.
❑ ■ 1113
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22_ Did the facility fail to install and maintain a rain gauge?
❑ ■
❑ ❑
23_ If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)?
❑ ■
❑ ❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ ■
❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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? ❑ ■ ❑ ❑
Page: 6

Permit: AWS090128 Owner - Facility: Baz Inc Facility Number: 090128
Inspection Date: 10110/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No NA NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ ■ ❑ - ❑
Otherlssues Yes No NA NE
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ ■ ❑ ❑
Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by 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 15torage Pond
Other
If Other, please specify
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 on -site representative?
34. Does the facility require a follow-up visit by same agency?
Page: 7

Type of visit: pL.ompnance inspection V vperanon Keview V ztructure Lvatuarion l.J iecnmcal Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: tt 11 Arrival Time: Departure Time: County: �� Region:
Farm Name: &e s C�--- Owner Email:
Owner Name: B 14 Z I r Phone:
Mailing Address:
Physical Address:
t
Facility Contact: its Title: Phone:
Onsite Representative:
14
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ne2LIL_11
Certification Number: 98s�3�
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
.
Capacity
Pop.
C►1 tie Capaci
Finish
La er
Da Cow
Feeder DO
7rFarrow
Non -La er
Dai Calf
o Finish
Dai Heifer
o Wean bOp
Design
' "Current
D Cow
o Feeder
Dry P,oultry
Ca aci.
P`o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Puults
Other
Other
Discharges and Stream Imoacts
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)
?. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑Yes
No
NA
❑NE
[:]Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
�No
❑NA
❑NE
Page I of 3 21412011 Continued

'Facili ` Number: - � Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
(B No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[j!] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FM 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 iind Drift ❑ Application Outside of Approved Area
12. Crop: 'n ��IPT .j jS41 cll � Q
T e �s () Co�s� _ � ram/
13. Soil Type(s): j 1 Gf�S� � 'M"
14. Do the receiving crops liffer 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
[;3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
© No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[�i 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 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
DNA ❑ NE
Page 2 of 3 21412011 Continued

Facdi Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�j No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
J q 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
1A No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Dg 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
�-
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91493
Date: 1/ /,3
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: BW� Region: FA19
Farm Name: CW Owner Email:
Owner Name: Z .�%!� Gr Phone:
Mailing Address:
Physical Address:
Facility Contact: ue, tk,�s Title: Phone:
a
t
Onsite Representative: i Integrator: A4 1&01�
Certified Operator: Certification Number: 99036
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design •urrent
Swine Capacity° Pop:
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Desigl
Current
Dry Cow
Farrow to Feeder
D , Poultr>
C►a aei
l;o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
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 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 CR No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes No
❑ Yes No
14 NA ❑ NE
U9 NA ❑ NE
VPNA
❑ NE
[DNA
❑ NE
❑NA
❑NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Ins ection: O
I IF
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P1 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[;g 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
` 0 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
0 Yes
M No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
`f-' No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
`p No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
10 No
KZJ
❑ 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?
7-
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 M Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
6&� %;// /X t Mr
13. Soil Type(s):AjTW vjN'e&y2Q[kA:bt
4-1
�
&
14. Do the receiving crops Jiffer from those designated in the CAWMP?
❑ Yes
P9 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?
T
T
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
Q9 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QgNo
❑ 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
to No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NJ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tp No ❑ 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 P No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[P No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
TT��
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
f No [DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
r
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WM P?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
�s-+w ..-.Z—n
Comments (refer to questionfff): Explain any YES answers�and/or_any additional.. recommendations or.:anyy4dIMr comments.
... : ..
...: - �,.rP�ih
• .• • . Y' • '`$eWy .t Nt t {'S; .
Use tawidgs.of facility.Ao.better explain situations -(use sddthonaltpages as necessary.}.
.. ?
Reviewer/Inspector Name:
Phone: j10-q3"3oa
Reviewer/Inspector Signature:
Date: Ia o2 u
Page 3 of 3
21412011

f
Type of Visit Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q F outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; 3 Departure Time: County: Region: f !mob
Farm Name: Owner Email:
Owner Name: 25 a Z it G, Phone:
Mailing Address:
Physical Address:
Facility Contact: L e —Title: 65—rry 'Wet - Phone No:
Onsite Representative: ��.4 [.c -z>� �+ g Integrator: .44k� 4is
Certified Operator: ,$t" i K s Operator Certification Number.92E�2-3 ,9`
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I = 11 Longitude: = o = . ❑ «
Design
C•unrent
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Layer
❑ Da' Cow
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
Dny Poultry
❑ D Cow
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ TurkeyPoults
❑
Number Structures:
❑ Other
Other
of
❑ Wcan to Finish
❑ Wean to Feeder
po
Feder to Finish
/Ebb ±��
❑ Farrow to Wean
p
Up
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
Ea -NO
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Freeboard
Observed (in): t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0No
❑ NA
❑ NE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
KNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 Ed No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ihs ❑ 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) ��jra-reC/
13. Soil type(s) r�—j1/¢ 0G 41,t l AJO# 3k rf
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 f9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ®, No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes KNo
❑ Yes QNo
❑ NA ❑ NE
❑ NA ❑ NE
Comments (�r fer to question ##) Explain any YESdwers. and/or any recommendations oa ny other comb meats „
.4..
Use drawings of facility to lietter.explain.situations. (use additional pages4s necessary):
No'�r LOvkt-ri c+�` ti.a-� a--� /-v 1127-e
Reviewer/Inspector Name 9/,9::5Z�:—33cDiz�
Phone:
Reviewer/Inspector Signature: Date: o i a
Page 2 of 3 1 - 12128104 Continued

Facility Number: — Date of Inspection U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JK 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 El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes rVINo ❑ 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 Jallo ❑ NA ❑ NE
❑ Yes RNo
❑ Yes 14 No
❑ Yes UR No
❑ Yes C&No
❑ Yes (RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[3 NA El NE
❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
❑ Yes
UJ�4o
r
❑ NA
❑ NE
[:]Yes
RNo
❑ NA
❑ NE
Page 3 of 3 12128104

t
� IMS �avS oq(lsj pg feu ,j Coey pa4o l rna;l,j_ a1,61n4 -
Type of Visit lorcompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit aRoutine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: $r / AM Departure Time: ,Qi County: Region: FPO
Farm Name: PPA-iorC Cree k &M f se) ky Owner Email:
Owner Name: tx —1- I G / Phone:
Mailing Address:
Physical Address:
r -
Facility Contact: S LLt�i n Title: Phone No:
Onsite Representative: Ti"tKh s Integrator: �b1'OaV�JYDW+f l a!M/1
Certified Operator: Operator Certification Number: AjyA 99.77,36'
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = Longitude: = o =' [—_1 u
Design Current
.Design Curren, Design C*urrent
R*, Capacityty Population
`'VerP Cap ity
PopulationryCatte� - Capacity Population
n to Finish
❑ La er
' ❑ Dai Cow
n to Feeder
rEaiFarrow
❑ Non -La er
❑ Dai Calf
er to Finish
❑ Dai Heifer
to Wean
D Poul �
❑ © Cow
❑ Farrow to Feeder
��
-� El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow,
❑ Turkeys
� I
Outer
❑ Turkey Poults
❑ Other I
❑ Other
Number of Structures:
M.
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE-
❑ Yes
❑ No
E] Yes
® No
❑ NA
❑ NE
❑ Yes
©No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

• Facility Number: —I 5SDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IRNo
❑ 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): �Q
Observed Freeboard (in): 40
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
CgNo
❑ 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 [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 JR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes [5jNo ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [5 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
1jiNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
& No
❑ NA
❑ NE
Reviewer/inspector Name SC { /� Phone: JR[0�t] `-933-1Q!2&�3.33
Reviewer/Inspector Signature: Date: 5' h
Pape 2 of 3 U 12128104 Continued

a
Facility Number: M Date of Inspection 16-7111
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N 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
5a No
❑ NA
❑ NE
❑ Yes
❑ No
UNA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
99NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
®'No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes RjNo ❑ NA ❑ NE
Additional.Comments and/,or Drawtngs 4 �;
ISM Wne was arrtW_ la'e -07l j
apt Sludge V01u+e WOT 4_7' iO Df +/676w4 1404-re- in VOA a 008, wi I I need.
C1?a,0,+ in nex+Sfl,,$aj years,
Pmp�j rvaS o bjelvd - On a reeU pi
Page 3 of 3 12128104

Facility No.�Farm Name
PW�C(P-e% Date
Permit COC ✓
,
Lagoon
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
,
Sludge Survey Date
Sludge Depth ft & %
,
Liquid Trt. Zone ft
a,
D, 4-)
Calibration Date
1
2
3
4
5
6
7
8
—Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date Wettable Acres Weather Codes
pH Fields WUP Transfer Sheets
Lime Needed Q .5l0, /A Weekly Freeboard RAIN GAUGE
Lime Applied We Rainfall Rainfall >1" ✓ Dead box or incinerator,
Cu ✓ Zn ✓ 1 in Inspections Mortality Records
Needs P 120 min Inspections
CroD Yield
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
1-
-
Mir
o - a,T
y-
D
a1
V,
C7s-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
Ila�o�
FRO or Farm Records
Lagoon #
Top Dike�0
Stop Pump 0
Start Pump-
Approx. Conversion- Cu-I 3000= 108 Iblac; Zn-1 3000= 213 lblac
App. Hardware��
S-)

� M v; I01031ox
Type of visit §a -Compliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit & Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: Departure Time: ,QQ County: 1310di6nRegion: 20
Farm Name: 1" Owner Email:
Owner Name: DZ T-rc, Phone:
Mailing Address: t� g� 116(_
Physical Address:
1
Facility Contact:�'(-Ill Title: Phone No:
Onsite Representative: Integrator: Certified Operator: J�n✓Q -S > iithf Operator Certification Number:AMA RM�
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = c = ' = u Longitude: ❑ o =
trtgign E Current =Design .Current
S,w�ne - pacity Population Wet Poultry CapSO Pop l tion Cattle
❑ Wean to Finish ❑ La er ❑Dai Cow
Wean to Feeder ` �1 ❑Non -La er ❑Dai Calf
Design
Capacity
Current
Population
Feeder to Finish
Q�jA
Dry Poultry
❑ La ers
�� 0 Dairy Heifer
r` ❑ D Cow
_
❑ Non-DaiTy
❑ Beef Stocker
Farrow to Wean
3
❑ Farrow to Feeder
[] Farrow to Finish
❑ Gilts
❑ Boars
ry ,.. ;._
Other❑Turkey
❑ Other
��f'i�a�ri m::'kt:�
ullets ers
❑ Pullets
❑
❑ Turke s
—_•x :.-ate;'
❑ Beef Feeder
❑Beef Brood Cowl
Number of 5tructures:,
Poults
❑ Other
-
Discharges & Stream I_mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EkNo
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: og —boa.
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): jqr s
Observed Freeboard (in): !3
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 �kNo
❑ Yes ❑ No
Structure 5
❑NA ONE
❑ NA ❑ NE
Structure 6
[--]Yes 7'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? ❑ Yes W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes [RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ NA NE
maintenance or improvement? ❑�,No ❑
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [RNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) CoR1tal mod& ( ilg-R_ �tS t►r h`'y, �` 1 .. -
13. Soil types) lVir�nik � LfllYi S S a-s ; O�lQ �, I_'J iS , T�'Wa- Kk S!
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IRNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? C'Yes WNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes MNo ❑ 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 ONo ❑ NA ❑ NE
r. 4ty �,� ),, y YES (�,... p g boas or any other eommen .
Eomments refer�to} uestson # E lain an answers and/or an recam�aaenda - ts.
Use drawin of facth to better a Iatn sttnattons� use�additional a es as necessary)•
t
Reviewer/Inspector Name N SCH&EIM Phone /o 33
Reviewer/inspector Signature: Date: 1 amow
(0
Page 2 of 3 1212NI64 Continued

r
Facility Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E� 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 appropiate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [5 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 QrNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No E�NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Mo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C3' No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
CR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[,NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
EjrNo
❑ 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
CgNo
❑ 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
IL'21 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
� No
❑ NA
❑ NE
I'�-k'h�S 011— los
�►2id,r l� ,9oc�.rha�-e of hers-I�
(baci -ean, we mrdS,
Page 3 of 3 12128104

1
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31L)-31
SAWY
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to
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r 50--1-3OraAlo
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_
a r,
313
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C _ /
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.5io}= 5 T = lq s-
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of
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-It
4 s Za I PtZ
1 7
330
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143-
qlfl -4
qa -
a

Division of Water Quality
Facility Number ®: 0 Division of Soil and Water Conservation
Other Agency I-) I L, I O�
Type of Visit '* Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: l Departure Time: (7 County: r) Region:
Farm Name: �e" f5 '�L� y yy-y Owner Email:
Owner Name: bckZ , ` V% <_ Phone:
Mailing Address:
Physical Address:
Facility Contact: P�_s n'ie7Y` Title: - f Phone No:
Onsite Representative: O �Integra r:
Certified Operator: �V L'' l�s Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = n 0 . Longitude: ❑ o = I ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer_ O Ot] ❑ Non -Laver
❑ Wean to Finish
Wcan to Feeder
fS Feeder to Finish
op
i o
❑ Farrow to Wean
Eg-Farrow to Feeder.
3 to
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
El Pullets,
ElTurkeys
❑ Turke 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Design Currei f..
Capacity Population
❑ DairyCow
[--]_Dairy Calf
❑ DairyHeifej
El Dry Cow
❑ Non -Dairy
El Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:Ell.
.f,£
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
❑ No
(NL NA
❑ NE
❑ Yes
❑ No
JaNA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
❑ No
WA
❑ NE
12128104 Continued

Facility Number —[Z
Date of Inspection tLlj�f�J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm
storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes * No ❑ NA ❑ NE
❑ Yes 1ANo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes J-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ 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 7A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% 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) Ley Ci l c-�n G Y Di S
13.
Soil type(s) N Oy —N a •Le— , G 1 P lT . 1V A
-A ,—rr-
—
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CgNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
14 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
] No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to betteradditional pages as necessary):
Jexplain _(use
j j,situations.
i U ��� S njY FJ
Reviewer/Inspector Nam T ��LAq kT70 Phone: Q WV
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection I 01
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)MNo ❑ 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
J4 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
AgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
f allo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
9NA
❑ 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
N 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
1� 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
qNo
❑ NA ❑ NE
E
12128104

Facility.No� cam ' ` �"�
Time In Time Out Date
,, , -
farm Name t—Q `"0.M, Sir Integrator
Owner i Y% Site Rep
Operator by _._ T No. 7 _
Back-up _ _ _.__. No.
COC
1 FREEBOARD: Design
Sludge Survey
Crop Yield ✓
Rain Gauge
Soil Test ✓
Weekly Freeboard _
Spray/Freeboard Drop
Weather Codes
Circle: General or NPDES
Design
Current
Design
Current
Wean — d
qa A
Farrow — Feed
can — Finish
Farrow — Finish
Feed —Finis
p
Gilts 1 Boars
-Farrow — e
(r oa
Others
Wettable Acres
C/ Daily Rainfall
Waste Analysis:
Observed
Calibration/GPM 1_ Z Z Z�� •�
Waste Transfers-�'
Rain Brea cer
r� PLAT
1-in Inspectionsf--
120 min Inspections
Date Nitrogen (N) Date Nitrogen (N)
o 1.9 .�-
�
Pull/Field Soil Crop Pan Window
ID vr�
L
r
-1
1�

Division of Water Quality
iFacility l�iumber Z Q Division of Soii and Water Conservation
-- — Other Agency
Type of Visit VCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit )ARoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 409
a Arrival Time: Departure Time: County: Region��
Farm Name: 65 �I '�0.!' hl� Q� Owner Email:
Owner Name: 01t1 .. hG Phone:
Mailing Address:
Physical Address:
Facility Contact: Lt n Title: & V Y Phone No:
Onsite ftepresentativ `"' Integrator., Y1
e
Certified Operator: is _ Operator Certification Number: 1. 65
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = if Longitude: = ° 0 i = u
Design Current Design Current
EM1e-ni
ulation
Wet Faultry
Capacity Population Cattle Capacity Population
❑ Dai Cow
❑ DairyCalf
I&RFe to Finish
O b [>
e) 0
❑ DairyHeifer
arrow to Wean
3 GOO
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
"'" El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
Otber
_.
a..
❑ Turkeys
❑ Turkey Puults
❑ Other
❑ Other
" -:;Number of Structures:
'
can to Finish
❑ La er
Wean to Feeder
a �
Non -Layer
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes t No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
NA ❑ NE
NA ❑ NE
❑ Yes ❑ No �NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ?No ❑ NA ❑ NE
12/28/04 Continued

Facility,Number: 0 — Z Date of Inspection l(
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
l❑
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
aNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(� 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
4No
❑ 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
o
to
❑ NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
❑ 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
$a No
❑ NA ❑ NE
maintenance or improvement?
Waste Api3lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes'ANo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) 1» r —C vlS
13. Soil type(s) A-k 1. No or— { Ty- 6 1^
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,V-No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesjNc,
No
[3 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesNo
El NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ YesNo
❑ NA El
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
:Comments (refer to question''#) Explainany YES answers and/or any recommendations or any other comments
Use drawings -of faeflity to better explain, situations. use additionalpages'as",nece9sar
A_ rro rl" rrlv r�se��sa r�ecQ
Aw kap U�3j�t�-'vim �C� C� b rl �� . ��� a s �1 � � >✓a'�S i n lti
U �j � s � /
Reviewer/lnspector Name � M�, �}� Phone: aJr
Reviewer/inspector Signature: Date: On V �P
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 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 ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 'KN. ❑ 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
PVNo
❑ NA
❑ NE
❑ Yes
J)_j No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑Yes
Wo
El NA
❑NE
❑ Yes
)gNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
C%NE
❑ Yes
IdNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes EgNo ❑ NA ❑ NE
jAdditional'Comments aodlor�Drawmgs - � "
QM,
Page 3 of 3 I21'28104

I *
" Facilit} No. Time In Ti a Out Date l'
Farm Name PP CQ� S cy-z_� I Integrator m
Owner //fi�r` 4 Site Rep
Operator �\l 1�� s - — No. r
Back-up No.
COC
Circle: General or NPDES
Desi n
Current
Design
Current
can —
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow
POO
Others
FREEBOARD: Design r, Observed
Sludge Survey 1 Calibration/GPM
Crop Yield
Rain Gauge {�
Soil Test" / 1
,Weekly Freeboard V
Spray/Freeboard Drop
Weather Codes
Analysis:
Waste Transfers
Rain Breaker
PLAT
Daily Rainfall
120 min Inspections
Date Nitrogen (N)
I10115 - -a - C�
o I I CPt o
IV 113L i z.
Wettable Acres
1-in Inspections
Date Nitrogen (N)
Z.
a5 -
--T
Pull/Field
..
..

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facifitv Number
Datc of Vkit: r d /O dTime:
� k
•—•- Ero Not Operational 0 Below Threshold
® Permitted M Certified [3 'Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: PAtIs L;rec k 56 w %4 r County:
Owner Name: /5 1 C, A G . Phone NO:
]Hailing Address:
Facility Contact: a n 8 i Z- C_ Title:
Onsite Representative: �o ��► .4 Vag _..—
Certified Operator: a
Locarion of Farm:
Phone No:
Integrator: —de32Z.) n
Operator Certification Number:
Swine ❑Poultry ❑ Cattle [3 Horse Latitude �` 0 w Longitude �' �• OK
Design Current
Swine 1 anarity Pnnnlalinn
Wean to Feeder
fjC>5
Feeder to Finish
ap
® Farrow to Wean
Ov
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Ca acity Population
❑ Laver I ❑ Dairy
❑ Non -Laver I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
No Liquid W
Discharges & Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharee originated at: ❑ Lagoon ❑ Srrav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notifi, DWQ)
c. If discharge is observed. what is the estimated flow in eallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area ILJ Spray Field Area J
s
❑ Yes ®No
❑ Yes ❑ No
3. Were there any' adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpiIlway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .3 9 "
❑ Yes ❑ No
NIX
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes [P No
Structure 6
05103101 Continued

'Facility Number: 9 — 1.? 9
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? questions 4-6 was answered [If airy of q yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancetiimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/ mprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �t.�rcof _SG CLS
13. Do the receiving crops differ w4 those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 M No
❑ Yes EP No
❑ Yes ®No
❑ Yes 10 No
❑ Yes ® No
❑ Yes 1P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes] No
❑ Yes IQ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

Facility Number: 9
Reouired Records & Documents
Date of Inspection
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ®.No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
ie/ WUP, checklists, design, Yes -No
(� gn, maps, etc.} �
23_ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes C9 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes O No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes (@ No
28. Does facility require a follow-up visit by same agency? ❑ Yes f No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slip questions 31-35) ® Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (R] No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes [A No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [A No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes til No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ I20 Minute Inspections ❑ Annual Certification Farm
.12112/03

I
Type of Visit tMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:ELIK03—Arrival Time: Departure Time: County: Region:
Farm Name: er!�r_ei c a' x_ �Q/rt_ _(sntj Owner Email:
Owner Name: — 7� 2 --FllG- Phone: ely�g3
Mailing Address: 'nA 7
Physical Address: :=M %SO 1
n7c— r
Facility Contact: Yt C!. L� ?Z�S�h _ Title: Phone No:2/� ���''�36-7
Onsite Representative: _ 5�� Integrator: 114aeI44 r-Otu_vt_
Certified Operator: f)k-it_ �i l�t ►Z Operator Certification Number: !qe
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` = Longitude: = ° = I = tl
Design Current
Capacity Population
�; ;Destgn ;. CU.
urrentLYNDSwine
WettPotiltry Capacityy ;Population
` s '�CaPacity Population
❑ Wean to Finish
❑
La er
❑ DairyCow
Wean to Feeder
OD
-Layet
❑ DairyCalf
Feeder to Finish
00 D
"°
Dry Poultry ''
La ers
?
❑ DairyHeifei
arrow to Wean
(n B``
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑
❑ Beef Stocker
-Layers
❑ Giits
❑Non
El Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Cowl
I
Turkeys
W. ..,, ❑
Other . El
❑ Other IE1
F •..
Numise�i of Structures:
Turkey Pouets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
q No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
XNo
❑ 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 ves, notify DWQ)
❑ Yes
®,No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ER No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5Q No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number• — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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): Jr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ER 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 13 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes A 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 [Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
MIA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
(0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21 No
❑ NA
❑ NE
Reviewer/Inspector Name i s:,, Phone:
Reviewer/Inspector Signature: Date: 3 ras
12128104 Continued

�l
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Jallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. KYes ❑ No ❑ NA ❑ NE
IN 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
O 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
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
62No
❑ 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
XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� No
❑ NA
El 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
El NA
[I NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
kNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
g No
❑ NA
❑ NE
� y
Al-e ra col d- 7~% u,
7� Gv.' // d+�D a T v
12/2&04

Site Requires Immediate Attention: , L
Facility No.
DIVISION 'OF•ENVIRONMENTAL MANAGEMENT
• mac. _
ANIrdAL FEEDI:a OPERATIONS 'SUE VISUATION RECORD
DATE:: 1995 : -:
Farm
Count
Integr
On Sil
Physic
Type of Operation: - Swim g Poultry : Cattle
Design Capacity: SS& Number. of `"mats on Site: 6nb .So U-> S
DEM Certification Numbs. ACE DEM Certification Number. ACNEW
Circle Yes or Na :-..-
Does the Animal Waste Lagoon have-;ufficient--;freeboard. of l- Foot' + 25 year. 24 hour storm event
(approximately 1 Foot + 7 inches) -.Yes or No .. = Actual Freeboard:j-`t Ft. LQ_jnches
Was any seepage observed from the Iagoon(s)?. Yes"or No Was any,erosion observed? Yes or No (Seepage was
Is adequate land available for spray?
,'Yes`'or..No';_Is the cover crop adequate?' Yes or No Not Evaluated
Crop(s) being utilized: S ra FieXd'roiccver��cro ' was not' evaluated
Does the facility meet SCS minimum setback critu... 200. Fed .from Dwellings? Yes or No
:M Feci--from Wills? Yes or No
*Is the animal waste stockpiled within l0a`FcrVof :USGS Bluiline'Strram?:.Yes or No*
* Is animal waste land applied or spray-.irrigaLed within 25 Fectfot USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state,by. man-made ditch;' flushing system, or-0ther
similar man-made devices? Yes: or'No- if Yes, Please Explain. ;
Does the' facility maintain adequate waste: . onagemehu record (volumes of manure, land applied,
spray ungated on specific acreage vhth cover.crop)?' Yes or -'No management records were not
Additional Comments: reviewedl — _
Thia_ was a very brief inspection: .a }more thorou h' insoection will be ctndurted in t future. -
Please contact.DEM should any 'condition -!arise that poses•:a danger to surface waters.
* This farm was not located on •a USGS -TOPO map to: -determine Mue Line" status.
If you have questions-conceftiag'this-report-please dd-not-heiitate to -.contact the inspector
at (91G) 486-1541. Please contact. -the -inspector, it the ".above Information is incorrect.
lspector Name ....Signatum
Fuility Assessment Unit ��1�' �j� Use Attachma�ts if Needed.