820135_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental 06

F%
ypc of v isir: V t,,_,,.,,,ommpnance inspection V operation Kevtew U Ntructure Lvamanon U I ecamcat Assistance
Reason for Visit: (9r/Routine O Complaint O Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: y i Arrival Time: ���, Departure Time: County: Region: rr RD
Farm Name: R qn \p vQP_m Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C_ t �R �'3 (t,\., o L Title:
Onsite Representative: _ _s4f % ff-st
Certified Operator: PF- QC & �rfls RC .\ taK
Back-up Operator:
Phone:
Integrator: M fiVkN o
Certification Number: )-7831
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
DIPNW esign Cuirrent.
Capacity Popes
Wet Poultry
Design
Capacity
,Currents -
.Pop"
Des1U Current
Cattle Capacity Pap.
Wean to Finish
',
La er
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
," 4 !
1
=
Dairy Heifer
Farrow to Wean
Design. Current_
Dry Cow
Farrow to Feeder
I
D , P,oul.
C_a aci_ty.
Po _
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
NJ I Boars
Pullets
Beef Brood Cow
Turk e s
Other
Turke Poults
Other
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [] Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page l of 3
❑ Yes [q No ❑ NA ❑ NE
❑ Yes
❑ No
&rNA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
[:]'Yes ❑ No
❑ Yes [5No
❑ Yes M4o
[2"NA
❑ NE
❑ NA
❑ NE
❑ NA
[] NE
21412011 Continued

]Facility,Number: ' a. - Date of Inspection: 1a.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [INA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑NE
Identifier: Z�
❑NE
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): =�1
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
[D"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
[y"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[V"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes gNo ❑ 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): G
13. Soil Type(s): k I 't _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3"No O NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (0'**No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ffNo ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps [:]Lease Agreements
❑ Yes dNo
[:]Yes E�No
[:]Yes E�fNo
❑ Yes 6/No
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes a'"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 E(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No ❑ <A ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: a, - Date of ins ection:
;:L-
24,
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19'No
[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[5 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
r
[2r 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [DDNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [dNo ❑ NA ❑ NE
❑ Yes [yNo
❑ Yes [3�No
❑ Yes [dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/inspector Signature: Date:a=1��1'
Page 3 of 3 2/412011

U
I Hf -Ivj q I
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1, Departure Time: County: ,,,/[ _ Region:
Farm Name: P —�T
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: a5_3] Phimp
Facility Contact: Pere l Q Title: QWnB^ Phone:
Onsite Representative:cl4 F C Integrator:
Certified Operator: �{�(,, py ie�o Certification Number:
Back-up Operator: ly/1�� Certification Number: �/XJQ
Location of Farm: Latitude: Longitude:
F
Deslgu* Current sa
Destgn *Current Design + Current
�Swtne�
Capacity Pop " #W.et Poultry
Capacity 'Pop
E] NA
Cattle Capacity Pop.
'No
❑ NA
❑ NE
Wean to Finish
z ,; Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean"
Dem Current
Farrow to Feeder
i DrvP._oult ,
Ca act
f Farrow to Finish
zf -_
Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
y
k., Turke s
Other
Other
�_ TurkeyPoults
Other
h -
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)?
Dai Heifer
D Cow
Non -Dai
Beef Stocker
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes � No ❑ NA ❑ NE
[:]Yes DRr
❑ Yes �No [:]NA [3 NE
❑ Yes
[D No
❑ NA
E] NE
❑ Yes
C] No
E] NA
E] NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
'No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Fad tv Number: - 3 Date of Inspection: gg 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
DJ -No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
rgNo
[DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
U No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
JSNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
DR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
F-1Outs°de of Acceptable Crop Window ❑pry Evidence of Wind! Drift ryry __❑ Application Outside of Approved Area
12. Crop Type(s): CAfi yyeffm ✓ 4- HOA
rave- PGa1vIe` SIn�E 11111)1'1 �y$5t° -
13. Soil Type(s):
W
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes IN No
❑ Yes 50 No
❑ Yes 10 No
❑ Yes No
❑ Yes No
❑ Yes No
[:]Yes No
❑ 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[�KNA ❑ NE
Page 2 of 3 2/4/2011 Continued

l:acili Number: Va, - 1= I Date of Inspection: 1Zj
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
IZU
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
Otherlssues
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?
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 p Lagoon/Storage Pond ❑ Other:
❑ Yes Callo [DNA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [W No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IQ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
N No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
tl�No
❑ NA
❑ NE
3 w .._
l; � tKer comments.
Use drawings of facr�#v to better explain: situations use addrt�onal, a es _as neves recommendations or ofl
Comments refer to ueshon # Ex lain an YES answers and/or ani addttiona
E P ( P g sa
a,The�aolo sl�c�e, S&,rU YVUf at
Q04-Islud eios�D�a of
s��. purch-0J5 if �,cL
sure bt(�fe_ end- of -yew,
r
-7, V# 30QL 1 aJ0010W5 cove,
y
FieU - j�c -far>�� �etoro�r Gine ren,qoad,sAaoe.
tlt7r cro y e lk -fam
Ther f rod wels have-
Pleoege'newjfvfe_
Reviewer/Inspector Name: l _P/1 Phone: -I to ]fp)
Reviewer/Inspector Signature: %Date:31
Page 3 of 3 /4/2011

Facility No. '3a-135- Farm Name
Permit ✓ COC
Pop. Design Current
Type
ftvl-e 531` 3q0?
Cpo1"n
Date perZ67-,)lYSo
OIC NPDES (Rain breaker PLAT Annual Cert )
FB
Dro
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date Y r
Sludge Depth ft
Liquid Trt. Zone ft 3
Ratio Sludge to Treatment Volume
CalibrationDate EMW 7,i Design Flow
Actual •d -------
Design �[�l�-------
Actua Width
Cu -I ✓Zn-I�
Needs P
Crop Yield
Waste Anal sis Date
Wettable Acres
WUP C----
Weekly
IWeekly Freeboard ✓
1 in Inspections
120 min Insp.
Weather Codes
Transfer Sheets t,
RAIN GAUGE
Dead box or incinerator
Mortality Records
Pull/Field Soil Crop Acres PAN Window Max Rate Max Arnt
1- i JS6G/- -d rg10
-I q
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 31 I IDSf Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike 15-)A
Stop Pump C;3. /
A
Start Pump 56 -,
Conversion- Cu -1 3000= 108 Iblac; Zn -1 3000= 213 lb/ac
App. Hardware
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu -I ✓Zn-I�
Needs P
Crop Yield
Waste Anal sis Date
Wettable Acres
WUP C----
Weekly
IWeekly Freeboard ✓
1 in Inspections
120 min Insp.
Weather Codes
Transfer Sheets t,
RAIN GAUGE
Dead box or incinerator
Mortality Records
Pull/Field Soil Crop Acres PAN Window Max Rate Max Arnt
1- i JS6G/- -d rg10
-I q
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 31 I IDSf Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike 15-)A
Stop Pump C;3. /
A
Start Pump 56 -,
Conversion- Cu -1 3000= 108 Iblac; Zn -1 3000= 213 lb/ac
App. Hardware

n
DIMS as 10 111
Type of Visit QCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -P Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit:Q SaM S
Arrival Time: nh Departure 'Time: � County.'
Ch
Farm Name:I -Fa)
Owner Email:
Owner Name: G [ a)fCIPhone:
Mailing Address:
Physical Address:
Region: 976 -
Facility Contact: � /Gly ©f 4.6- Phone No: 5 j
Title:
j�.�
Onsite Representative: Xffcy 4- ltlh i S C I V i ) Integrator: � — _
Certified Operator:
rl ��-� Operator Certification Number: 17S.3)Back-up Operator: wfD 1y 11 l�rc�D 'Back-up Certification Number: h
Location of Farm: Latitude: 0 0 =I
= u Longitude: [� o = i
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 allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Design Current
Design Current
Design Curreoo nt
Swine Capacity Population
WIZm-et Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder zry
j[__1 Non -Layer
❑ Dairy Calf
Feeder to Fin isha
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean ISDO
Dry Pout try
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑
Number of Structures: El
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑]rN`,o
El NA
El NE
❑ Yes
lwo
❑ NA
❑ NE
❑ Yes
tXNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: 'a — (3 Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ 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): C(
Observed Freeboard (in): 3'3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
15-d'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
RNo
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
1�kNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
EdNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ISNo
❑ NA ❑ NE
maintenance/improvement?
11- Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C5CNo
❑ 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) �C 'Mu�0. A3 f1a� , Small &fdlb oye- 4
13. Soil type(s)
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ET10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C5kNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[F No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JR No
❑ NA
❑ NE
Reviewer/Inspector Name ; i � . ..E(�� Phone: 9f U y33- --
ReviewerlInspector Signature: p,L Date: Dd-a6,A-0 fo _
Page 2 of 3 U 12/28/04 Continued

Facility Number: a, — rj Date of Inspectiona�d�l
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tS-No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other _ _
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [RNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1JNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
QR�4A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ffNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tgNo
❑ NA
EINE
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
�FNo
❑ 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
tffNo
❑ 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
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
er Svot, no� ea d 6efre eid oPlOse,& add Or 01 P_ &-f
I vtsi;,dgeis �1Q 169 to
is o o whet ratfQ re Q,� 50 e V"7
l� -f o c.��e h o&+sl �ge-
p0A witha
w� h G &o days
,o,d-f
r fix aooa �cC mall a �tv o e �br ���► �%.
�wlll r►rr�f� � sl 9e aha 9 �'y
:P� press ore- oveli eedr!!� Y,
Noon 6rgya- Co
CS(�(3�t� Surve �Pf0 o Mrks ee6- Ord- ftA Wl'' 4 1E�t'•�'S 4"``�7�
Page 3 of 3 12/28/04

Facility No. '0- (31 Name Pfc Date
Permit COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert)
Pop. Design Current FB
Type. Qrops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
mons
Design Width
— am
Actual Width
Soil Test Date I p
Wettable Acres -- RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections f
Cu -I -- Zn -I
120 min Insp.
Needs P
Weather Codes
Crop Yield
Transfer Sheets
Waste Analysis Date
off
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
- a -SP
Verify PHONE NUMBERS and affiliations
Date last WUP FRO !d j to Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac.

Type of Visit f?:k Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r Q Arrival Time: ,157A Departure Time: 'fT County: "R 0 Region
f� 1
Farm Name: T G ( Owner Email:
Owner Name:Vero_ P6tIt L _ Phone:
Mailing Address:
Physical Address:
Facility Contact: t� Title:
Onsite Representative: Pr�r" 4 y a Y p4lyc_r 04
r �
Certified Operator: j rctolA
Back-up Operator: P4-1
Phone No:
Integrator:
Operator Certification Number:AwA 17&- _
Back-up Certification Number: Aw7q I7g io
Location of Farm: Latitude: [� n [= d = Longitude: = ° 0' E__1 N
Design Current
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current
Design gent
Swine Capacity Population
a. Was the conveyance man-made?
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Yes
❑ Dairy Cow
❑ Wean to FeederI
I0 Non -Layer I
I
❑ Dairy Calf
g Feeder to Finish 35
❑ Dairy Heifer
❑ Farrow to Wean
❑ No
Dr,F Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
�INo
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑Other
lVumher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
�INo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

e
Facility Number: 43 a Date of inspections
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5TNo ❑ 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): z5 12
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes fR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J}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 ITc[No ❑ NA .❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes BNo ❑ 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) (1jfA j0( brm t.rjA ( Rn., 4 Na it wvol • S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ET No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ea -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ERNo
❑ NA
❑ NE
( q ). p k.. necessary)::y Ij
Comments refer to question #): • . Explain any YES`answers§and/or an •recommendations or an other comments ��
Use drawings of facility #o better explain srtuahons (use addthonal pages as
Reviewer/Inspector Name j AN Se - �� Phane����] y�� -,�.i����JY
Reviewer/Inspector Signature: Date: Sf i cl Qtr
( 1 12/28/04 Continued

Facility Number: ga, — S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EiNo ❑ 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. ❑ V*1Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9INo ❑ NA [I 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 1E] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [aNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes O No
[:INA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes "S No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
eldi) q reodj- 1'.. .")ad -
w
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
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ETNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Aanai Comments audfor Drawings:
�c_QIh'a�?t;��rvey b�� �� O�'Ct�
r ly
y! i is W f �Cv't-om).-q
eldi) q reodj- 1'.. .")ad -
w
12128104

I
Facility No. Farm Name
$0
Permit COC
Pop. T e Desi n Current
Pr Date 11 f 11 .
OIC �-'` NPDES (Rainbreaker PLAT Annual Cert )
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & % Q
Liquid Trt. Zone ft
F X"44 fl rSlJn,
Actual Flow
Design •Width
�-------,
--Actual Width
- i -------
Soil Test Date .�
Qn
�r
pH Fields G.
Lime Needed 0
Lime Applied
Cu
Needs P 0
Crop Yield --
Wettable Acres
WUP
Weekly Freeboard ✓
Rainfall >1" -�
1 in Inspections
Waste Analys-is —Date IRM �tRLTI�CIFHPMM
120 min. Inspections
Weather Codes
Transfer Sheets n !r
RAIN GAUGE
Dead box or incinerator
Pull/Field Soil Crop RYE PAN Window
Max Rate Max Amt
N
wkv 11 3J 3
q
!D —3
Verify PHONE NUMB RS and affiliations
Date last WUP FRO �Qq Ft q il� Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike 3T9
Stop Pump 53•q
Start Pump j�, r
App. Hardware
wvO

C
Type of Visit I$It Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral o Emergency 0 Other ❑ Denied Access
Date of Visit: 11oinal Arrival Time: Departure Time: 110"qFM I County: salnlqsRegion: FRO
Farm Name: Pf4 ffrjut� Fe" Owner Email:
n
Owner Name: '�t�l C ) rC 0� Phone:
Mailing Address: a t�1.� Glyll� s��l �os� horn g�
Physical Address:
Facility Contact: �$ t?!I rd Title: © Phone NoAWA
Onsite Representative: c40 r-7dC` Integrator: HW9h1.-kW n
rI • if
Certified Operator: QiC ) rc Operator Certification Number: A'✓%4 1-73:u—
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0
= = « Longitude: = ° =I = u
Design CurrentJIM Designer Current Design Current
PPE3Wean
@apacity P ulah A r WeIPUultry Capacity §Pop 1 hon' Cattle Capa ty Population
.
F
o Finish ­❑ La er M ❑ Dai Cow
to Feeder ❑Non -Layer El Dairy Calf
Feeder to Finish 3S«" ' ❑ Dai Heifer
❑ Farrow to Wean ❑ D Cow
pDry Poultry
❑Farrow to Feeder -' µ El Non -Dairy
❑ Farrow to Finish ❑ Layers' El Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Boars ❑ Pullets k El Beef Feeder
❑ Beef Brood Co
t. a ❑ Turke s,
} a
Other+�� ❑ TurkeyPoults
❑ Otherj-
E [_1 Other umber hN
of Structures-
'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CR -No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�TNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
� o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

• Facility Number: 4&— 3S
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LVO
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W 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 J�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 tgNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CRNo ❑ 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 CRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NNo ❑ NA ❑ NE
maintenance/improvement?
11 _ is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ® 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 U❑ Evidence of Wind Drift [I Application Outside of Area
12. Crop type(s) Coada I �'RW� 1� 4 P/ ' S[9 Q f
13. Soil type(s) J a 1_5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 12No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? cEryes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
t�rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
CSOqo
❑ NA
❑ NE
} - -
;Commeais' {refer to queshon�#) E lam an YES`.answers and/or an recommendations or°an,other comments.
y Y_ Y
Use drawings of6facili7ito bettevexplaul situawns_. {nse.#additional pages as necess ry) :
Reviewer/Inspector Name'nN Sc�!E
Phone: io 433 333w x 3
Reviewer/Inspector Signature:
Date:waamr
Page 2 of 3 V 12/28/04 Continued

Facility Number: $ a, — �j�- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
DrNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
INA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RrNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3I .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
tRNo
❑ 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
JRNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
Additional Comments and/or Dra in,
15E P)P*e coi o 1 f! wWe fin P0A*P_
YV I I �rojxb� nf�-,b limes Y) &Iy�.
as. E� rah s !tel �s+,ve -ew a o a
Vv f in � 4�1e. �n aoo ,
�y, VV; l! n>o. calf bra, nftt y"'.
wa mab►-lowk
Page 3 of 3 12/28/04

Facility No. `x-13 Farm Name
pernfNv
�fc r
Date
Permit "-*, COC ✓
O 6
NPDES (Rainbreaker
Pop.Type Design Current FB Drops
I AA YAr M-12
PLAT Annual Cert)
La on 1 2 3 4 5 6 7
Spillway
Design freeboard —y
Observed freeboard in
Sludge Survey Date Perm Liquid ft
Sludge De th ft
GXfd�i�[h u�i a QLUL^f
Calibration Date
..Aesign Flow
Actual Flow
lesign Width
Actual Width
-------
Soil Test Date 1 in Inspections �✓
Crop Yield
pH Fields 120 min Inspections
Wettable Acres �
Lime Needed �-Lly�r-� Weather Codes
Wee
Lime Applied II WUP Transfer Sheets
Cu ✓Zn7 kly Freeboard RAIN GAUGE
Needs P 0 Rainfall >1" ✓
.I No!.
Oki • I
Pull/Field Soil Crop RYE PAN Window
a�
Verify PHONE NUMBERS and affiliations .✓
o _ �j 000 3%00
Date of last WUP FRO Da e�of�{ WUP at farm App. Hardware Age/
IlAw N071
Top Dike 51,$ I
Stop Pump 153-i� Alvl, 3a
Start Pump y4.1 r i0A
hunt It of -43 *% 1115
'DW in
Max RateC16 Max Amt"1.0

Division of Water Quality
LFacifity Number Z 3 O Division of Soil and Water Conservation
O Other Agency
d C6
11 1r, I
Type of Visit 39 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11AS 0 Arrival Time: M 60 a Departure Time: County:
Farm Name: ` ; {� i(M Owner Email:
flwnPr Nnmrr 14-661(A— Phnnw
O
Mailing Address:
Region:
Physical Address: y
Facility Contact: V_e1 Title: _ 11J ti t 1 . Phone No:
Onsite Representative: Fa -f Integrator:
Certified Operator: I __ rr(� Operator Certification Number: [ 1
Back-up Operator: 01 ! c 111— Back-up Certification Number:
Latitude: =' =' [:] « Longitude: [=]O=' ❑ "
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkev Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daity Heifei
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 10
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 P(No ❑ NA ❑ NE
❑ Yes ❑ No
RNA
❑ NE
❑ Yes ❑ No
[ LNA
❑ NE
❑ Yes ❑ No
EJ NA
❑ NE
❑ Yes Wo
❑ NA
❑ NE
❑ Yes ❑ No
di NA
❑ NE
12128104 Continued

Facility Nbmber— f .
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?
❑ YestNo
o
El Yes
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
st-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan? 9
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 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes No ❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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)
S
13. Soil type(s) " u
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 7�ko [INA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes "LNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes `RNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Sri ME 6LA K)T Q Phonc:,,-i tzq3 3314
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection EYME
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ONA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
$iT-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Y3NA
❑ 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
❑ YesNo
PQ
[INA
ElNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
rr
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
— Q� 40.�'r 54y'01 ov� CSYN ITYl (–OvY1e-Ir- _
AL
12/28/04

Faci:ity No. � Time In Time Out ate I Z1 S
Farm Name Q_�{ G,, �� ` _ Integrator 1 ti ti —
Owner UAL, Site Rep
pa
Operator No. -1-1 C?
Back-up A
No. j
COC ircfe: enera or NPDES
C
Desi n Current
Design Current
Wean – Feed
Farrow – Feed
W – Eiagsh
Farrow – Finish
Feed –Finis C)
Gilts / Boars
arrow – Wean
Others
FREEBOARD: Design c,
Sludge Survey �t �3 �� q. l
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
l l
Z, -
Observed
Calibration/GPM /
Waste Transfers i
Rain Breaker
PLAT
1 -in Inspections
Date Nitrogen (N)
13 Z .g
ut
Pull/Field Soil Crop Pan Window

Type of Visit ®-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit <01'12outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: .26 Arrival Time: ® Departure Time: County:
Farm Name:-PIPMt`_u c1clu, �Yjnt ie Owner Email:
Owner Name: �QS (`" � ird of
' Phone:
Mailing Address:
Physical Address:
Region_
Facility Contact: 1�4IF OC W Title: Phone No:
Onsite Representative:C>xi Integrator:
Certified Operator: ��y�f �L Operator Certification NumLN
ber: I ��
Back-up Operatortzia E tftla x -CU, Back-up Certification Number:
Location of Farm: Latitude: F__] ° " Longitude:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 discharye?
Page I of 3
❑Yes �No [:1 NA [:1 NE
❑ Yes
DesignCur t
NA
DgnrCiirrent Design Current
ll
Swine
Capacity Population
Wet Poultry
CapacityPopulat�on_ _ C►attle Capacity Population
to Finish
❑ No
❑ Layer
❑ Dai Cow
to Feeder
KhNo
-Lay er
l>. ❑ Dai Calf
rto Finish
3520
❑ NA
`t° ❑Dai Heifer
w to Wean
❑ D Cow
w to Feeder
Dry Poultry-�f�
" " ❑ Non -Da'
EFarrow
to Finish
Beef Stocker
rs[]
Beef Feeder
Pullets
Beef Brood Cowl
❑ Turke s❑
❑Turke Poults
ther
Number of Structures:
=:>
6 r:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 discharye?
Page I of 3
❑Yes �No [:1 NA [:1 NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
KhNo
❑ NA
❑ NE
❑ Yes
4�9 No
❑ NA
❑ NE
12128/04 Continued

Facility Number:1 � 3�j Date of Inspection d oZ
Waste CoI� & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier:
Structure 2 Structure 3 Structure 4
❑ Yes UNo ❑ NA ❑ NE
❑ Yes ❑ No [RNA ❑ NE
Structure 5 Structure 6
Spillway?:
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No [:INA
❑ NE
t
Designed Freeboard (in):
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Signature: Date:Q_ ZDZ7)
j
Observed Freeboard (in): 3 1p
into Bare Soil
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes N%No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes 1�)No
❑ NA
❑ NE
through a waste management or closure plan?
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ANo ❑ 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 Wo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes W No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18.
Is there a lack of properly operating waste application equipment?
❑ Yes %WNo ❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes [QNo
ElNA
[INE
maintenance or improvement?
JJVV
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes R)No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No [:INA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Signature: Date:Q_ ZDZ7)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
Evidence of Wind Drib ❑ Application Outside of
❑ Outside of Acceptable Crop Window E] Evidence
Area
12.
ce�
Crop type(s) LLC/ (
iZ,"l L I�asluy�.0 IOLn 015
13.
f T_
Soil type(s) t—i 04fWN.11K
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ANo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
[:]Yes XNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 71 No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes -1;*No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes %WNo ❑ NA
❑ NE
Comments (refer to question #). Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name _ �. I Phone 3
Reviewer/Inspector Signature: Date:Q_ ZDZ7)
Page 2 of 3 12/28/04 Continued

Facility Number: — 23 Date of Inspection a(q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropriate box. ❑ W Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '*$No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
,j'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JkNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
-;4-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
*o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
MNo
El 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
lyjNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
';kNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
)} No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Additional'Commehts'snd/or`Drawings: ,
V,�1 lex, � FcLv
IA�l1 M1�1Y1 �' ryen-l'Awi .
Gcor 5 i r1 p� of C4 ,
Page 3 of 3 12/28/04

Facility No. Oc 135 Time in� Time Out DateQ o)(P L,
Farm Name 01 � VCUV W\. ^_ Integrator _
Owner Site Rep
Operator _ r QAC No. „ 1 )
Back-up _ �`la�l No. P>o
COC Circle: General or rNPDES
Design Current
Design Current
Wean -- Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
,Fave—dd — Finis
Gilts 1 Boars
arrow — Wean
Others
n
FREEBOARD: Desi n Observed
Sludge Survey 0 IL- Calibration/GPM 1
Crop Yield Waste Transfers
Rain Gauge / Rain Breaker
Soil Test -11/1 PLAT
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop pq 0 C-
Weather Codes 120 min Inspections
Waste Analysis:
Wettable Acres
1 -in Inspections
Date Nitrogen (N) Date Nitrogen (N)
j01 9 ' 3
(_q119 2.4
Pull/Field Soil Crop Pan Window
v
3

9.
1 ype of Visit 4D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: G -/,3 -d e� Arrival Time: Departure Time: County: JO -10412-1 — Region: lSef2
Farm Name: _f!jc_ 62,; -G& A „5etrM Owner Email:
Owner Name: Pe Phone: ! - 3!19
Mailing Address:H,2we. .S& -M -92a.1 _ Aagd"
Physical Address:
Facility Contact: aad eirs. &/,.r Title: Phone No:
Onsite Representative: _/fl/,Qn M/S Fc�;��>{g�1 Integrator: ae-POC 1/4lu4oAx -Bro
Certified Operator: Pe I`r.. <FFe kG.'164 Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 6 =I=" Longitude: = ° u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other, - - -
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
1'_
Design Current
Cattle Capacity Population
❑
Daia Cow
❑ Dai r Calf
❑ Daia Heifei
❑ Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Dumber of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Q -Ko
❑ NA
❑ NE
❑ Yes
U - o
❑ NA
❑ NE
12/28/04 Continued

1 !
Facility Number: 83 — J3 i Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9-14 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:"
Spillway?: 01 a
Designed Freeboard (in): _I_q "
Observed Freeboard (in): _ ,Adj f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9,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 [allo ❑ 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 [r 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)
4. 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
F'No
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[3No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
.2 YS 60
12. Croptype(s) (f,2,2,&1
13. Soil type(s) id N
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
DeNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[ o
❑ NA ❑ NE
16. Did the facility fail to secure andlor operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA C E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
NA NE
[:1[]
18. Is there a lack of properly operating waste application equipment? ElE Yes
No
❑ NA ❑ NE
ally YES answers andloraa�y
''sitiiahoni: (use',addrtion-Ai Ps€
Jp4.,$ /" -5Ar paee l3 GJ neC«ssar,. T. ��rrrenf at �..re� rros�.,
Reviewer/Inspector Name ha � '� .. Phone: g167 NG /12V_ 710
Reviewer/Inspector Signature: Date: G /3—C) 57-
12128104 Continued

Facilih, Number: Date of Inspection F&__ -13 -OS -1
Re
G-I -OS-
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0lqo- ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ >b-11- ❑ Ch.9p sts ❑ ik5ign 0344's ❑ C r
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes @-<o ❑ NA ❑ NE
❑ ❑ y ree ❑ LJ-R�� ❑ ❑ n
❑.Ratite- ❑fig ❑za43, d- ❑ I s ❑ . tions ❑ode
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
Q^<o
❑ NA
❑ NE
❑ Yes
AVO
❑ NA
❑ NE
❑ Yes
E],Ko
❑ NA
❑ NE
❑ Yes
Bl�o
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
205o
❑ NA
❑ NE
❑ Yes 9'<o ❑ NA ❑ NE
❑ Yes 9 -mo ❑ NA ❑ NE
❑ Yes U Ko ❑ NA ❑ NE
❑ Yes 04o ❑ NA ❑ NE
❑ Yes
D - Ko
ElNA
[:1NE
❑ Yes
9'1�o
❑ NA
❑ NE
Additional C "' mems and/or E r
fix 1 T:� 3 flu
/�
21 TS KlrO;#' J Crop
y,eldt !eeoatls,
please -se A OOedmed 'Av O",
61
12/28/04

Type of Visit * Compliance Inspection 0 Operation review 0 Lagoon Evaluation
Reason for Visit Qlroutine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilitv lumber pate of Time:
=Notrational Below Threshold
M -Permitted Certified ©Conditionally Certified M Registered Date Last Operated or Above Threshold:
Farm Name: A -11 4e _ _A�� /W r-ACounty: -_540mJ9.1424 A140
Owner Name: Al r Fd.o Phone No:
Mailing Address: %fgxzy JS --elU ORO/ Ro
Facility- Contact: __ Pprr,4 Aa, rc%U Title: Phone No.
Onsite Representative: __ �re C" _4Aa /4 Integrator: AIVC.7A.
`� 77
Certified Operator: P� rr.i Fo{rr'UA Operator Certification number: MJ71
Location of Farm:
Ly'Swine ❑Poultry ❑Cattle ❑ Horse Latitude Longitude 0' �• �-
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle capacity Population
❑ Wean to Feeder P Lavcr ❑ Dairy
ceder to Finish JE1 Non -Lave,- ❑ Non -Dain,
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JIJ Lagoon Area JE1 Spray Field Area)
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges 8 Stream impacts
I. Is anv discharge observed from any part of the operation?
❑ Y�
es o
Discharze orininated at: ❑ Lasoon ❑ Snrav Field ❑ Other
a. If discnaret is observed, was the eonvevance man-made? ❑ Yes ❑'bio
b_ If discharge is observed, did it reach Water of the State? (if yes, notifv DWQ) ❑ Yes EK
-0
if discharge is observed, what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes O'1lo
2. Is there evidence of past discharge from any part of the operation? ❑Yes 2 -Mo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [I -No
Waste CollLction & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 94 -N -0 -
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): o
05/03/01 Continued

Facility Number: ;j — 13 5 -
Date of Inspection- +�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes Biro
❑ Yes [! No
❑ Yes Q No
❑ Yes 914o
❑ Yes 21�o
❑ Yes B'fio
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes EJ4 o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type dt/'•"✓de �ra.',n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes QITo-
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 atlor 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 9"So
❑ Yes @'lqo
❑ Yes a'No
❑ Yes ❑ No
❑ Yes 94<6
❑ Yes ❑ No
❑ Yes Rice
❑ Yes [QNo
❑ Yes [;-No
Camhients iffier W -es6oa k = an YFS answe s
:a) yandlo� aay recommeons o_ any otliercornts:� ter;
=Use dr?awmgs Esf f cdity to beater explarn setnado s. (use add�teID as necessary") Q meld Copy 0 FQ Notes
Fie'
M
r.3..._,.ax...x
fie, -n4 s,1,e l,4l51+
Tar
�
Tl 4,f A*e4l s,t 6pre- Glias Wwflnol /4,500A, &�trSl ►'t %S>� >!'
L0VCr ba,e
ureas
- Reviewer/Inspector Name�= t
vj r/reDate: _d
12112103 Continued

Facility Number:Ar�L_ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the ility �9 to have all components of the Certified Animal Waste Management Plan readily available?
Get, ce4eefflists,gn, ,etc-)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑AVasU"pphcaNerr ❑ 1?reebowd ❑ Vkste-Axzlysis ❑ Sail -S=pli @
09f-7 3.0 4-6y-:�a1(0 y-oy -9 ;),(0 -7-.%p>>.1
24. Is ility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Pail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ SN"kl4erm ❑ ieid-Few ❑'mar- ❑
❑ ❑
❑ Yes iso
❑ Yes ❑440-
❑ Yes 9-96-
0
-Qo
❑ Yes S -No
❑ Yes [-b
❑ Yes S -No
❑ Yes O -WO
❑ Yes B-lgo
❑ Yes [31go
es ❑ No
❑ Yes
GWo-
0 Yes 2No
❑ Yes Brro
❑ Yes B' O
❑ Yes 9R?d
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddit16h a Comments and/c3r Drawings �- �'� " -. -
�„�_.,�.
r
12112103

Site Requires Immediate Attention: No
Facility No. Va_z3c5-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: AT , 1995
Time: 15: IS'
-Farm Name/Owner:
'Mailing Address:�
:County: Sainpann
Integrator: Camp's r=;=As nr. _ Phone: Lq�o S o 4
On Site Repn:sentative: j} ,.,� W.AVse., t is*roily raa_. Phone: rggo) c -a -x 41
Physical Address/Location: A124'S ., t.s eC L6kAwc -'.0-e, 61 _ -e 12-4-s- � nrC-21
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site: ssao
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:� ° 4a' I S" Longitude:.$ ° �'�"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) (e or No Actual Freeboard: SL Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or l&Was any erosion observed? ®or No
1s adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? � or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No a%V. a wla�.kj
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes or�& If Yes, Please Explain.
-Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No co, e�
Additional
Comments: • 1 .
TT:s Baa u e,-bt:e-k- �I+s�tr1-tcrr. _ A mate- .i..t,to.V!Sl .% i/1 7CGiti[1��c[7i,1 :� ri.r _
- -U �% c V— Zpu % V.
Inspector Name C �cc Signature
.�di iC 7�, �iaGt�ev:4 Qld,
r y #-lka.. [!e Ne aa3o r
cc: Facility Assessment Unit Use Attachments if Needed.