820221_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

1pe---.7-
(Type of Visit: (2rUompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergenev O Other O Denied Access
Date of Visit: _ Arrival Time:
,' �� Departure Time: O'. c7 �, County: eY— Region:
Farm Name: ��yft, y �� j % a f' m� _ Owner Email:
Owner Name: {���,� Phone:
Mailing Address:
Physical Address:
Facility Contact: t-yer'-70 S Title: &)P_0 ti Phone: 1
Onsite Representative: � , _ Integrator: _ Sjr, �t-1
Certified Operator: Certification Number:
Back-up Operator: ,s Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine GTDRCVM
Wean to Finish
Design Current
Layer
Dai Cow
Design Current
Capacity Pep.
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
I'll
Design Current
Dr. P,onl Ca aci P,o
Layers
Dai Heifer
D Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
TurkeyPoults
Beef Brood Cow
rLOther
12,
er _
LiOther
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
[:]Yes
®'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Q o
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
D ""
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D"IVo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑,Yes
[�1Go
❑ NA
❑ NE
of the State other than from a discharge'1
`
Page 1 of 3 21412015 Continued

facili Number: Date of Inspection: ?
ZZ 7—
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 [D"No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I '�-
Observed Freeboard (in): `2 %
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �NoEl [] NE
❑ Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [1Io ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [] Yes [3Ko ❑ 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 O'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LJ N' o ❑ 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)://z
13. Soil Type(s): 74�- a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[DINo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F,7"�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E3-1�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]lo
❑ 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
E 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
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ Na
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - �- Date of Inspection: 7-L
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 []'1lo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
#): Ezpla
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
,es as necessary)..:
bl'V <7 g-, I j-j�
❑ Yes
ET'No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑Yes
Q o
❑NA
❑NE
❑ Yes [ o [] NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [J"No ❑ NA ❑ NE
[] Yes
[3 No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
DNo
❑ NA
❑ NE
Phone:/3`Z_
Date:
Page 3 of 3 21412015

M
a
"vision of Water Resources
Facility Number - INDivisioa of Soil and Water Conservation
0 Other Agency
Type of Visit: erCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: OlCoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; D D Departure Time: County: Region:
Farm Name:
Owner Name: y-_'L- ass_
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: . yin -f-4 �Ud5 S Title: Qwill 'r-' Phone:
Onsite Representative:
Certified Operator:
Back-up Operator: ��j,� v ,E"'
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number: /�jj II/ly -
Longitude:
01
Swine Capacity Pop.
Wean to Finish
0 Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer airy Cow
Wean to Feeder
t7ap
Non -La er Dai Calf
airy Heifer
Design Current D Cow
Dr. P,oul Ca aci P,o . Non -Dairy
La ern Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ern
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No [:]NA ❑ NE
[]Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [2LNo
❑ Yes 2 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection:
J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3 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
2,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ANo
❑ NA
❑ NE
maintenance or improvement?
Waste Aanlication
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 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): :��—/ Z Vct 1 o U �_1 `31_6�1!vl
13. Soil Type(s): rlq-F
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [qNo 0 NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [J'No ❑ NA ❑ NE
❑ Yes qNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
(3,,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[R No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3.Lo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: — 1-2
—
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®, No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [INo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rV2311No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes fa No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes JE� No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes r No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: �Jp'3DlS t'
Date: 7 i; �7
21412015

Date of Visit: , J Arrival Time: Departure Time: /! ,' f County: Region: Fg-b
Farm Name: _Lz-"Pg .y 13�t��, j�Cry�-� Owner Email:
Owner Name: rt x Phone:
Mailing Address:
Physical Address:
Facility Contact: _ z—rt yr 63 Title: 19•cun r-✓ Phone:
Onsite Representative: Integrator:
Certified Operator: ✓ Certification Number: lL�/
Back-up Operator: C�jrjr, /� a s5 Certification Number: _./ Ealj
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design °.Current
Capacity
Pop.
Wet Poultry
Non -La er
D . P,oultr,
Layers
Design
Capacity
Ca eci
Current
Pop.
P,o .
Design Current
Cattle Capacity Pap.
airy Cow
Dairy Calf
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Wean to Feeder D
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
1
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other ,_
Other
ITurkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[-]Yes C4Vo ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [:]Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [—]No
❑ Yes �&No
[:]Yes C .No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[!jYo
❑ 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): f C�'
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
f,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
WNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes tC 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): .L''/ZZIt t l- 119y r-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes En -No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes rNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3,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 2 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LZ-No
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: if- Date of Inspection: 7-- 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5INo ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fallo ❑ 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
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?
NCIJ ert 1'— U ✓
-51--r v � '�_V- y fo '__ � r-
Reviewer/Inspector Name:
❑ Yes No ❑ NA ❑ NE
❑ Yes [2�No ❑ NA ❑ NE
❑ Yes [5No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes q No
❑ Yes allo
❑ Yes ONO
M
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Departure Time: ' vD County:. Ste„ , Region: ,0
Farm Name: . ry1 fit/In Owner Email:
Owner Name: e-t-22 n iLJ �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Lea Title: g4fo-ell e Phone:
Onsite Representative: fr.. Integrator:
Certified Operator: ��,�.-�— _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
`Cnrrent
Design Curren#
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle CapacityPop.
Finish
Feeder
83a0 v
Layer
Non -La er
Dairy Cow
Da' Calf
o Finish
Da' Heifer
to Wean
UFarrow
Design
Current
Cow
to Feeder
Dr. P■■75ltry
Ca aci.
P,o .
Non -Dairy
to Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
ML_LOther
Other
Discharges and Stream Impact
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [5 No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
[:]Yes ®1No
[:]Yes [3-No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E.No
[DNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[EL No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
SNo
[] 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
R,-,,,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s): 1
13. Soil Type(s): f"t—T
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 E. No
❑ Yes allo
[—]Yes CNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ®No [DNA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �.No ❑ NA ❑ NE
WUP ❑Checklists ❑ Design ❑ Maps 0 Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E[ 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 U No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [allo ❑ NA ❑ NE
[—]Yes allo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
❑ Yes a No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question Explain any YES answers and/or anyadditional recommendations or any other cameo .
Use drawings of facility�to tietter,ezplain situations (use additional pages as necessary).
Reviewer/Inspector Name: _�/-� �-- Phone: -4>
Reviewer/Inspector Signature:Date:
Page 3 of 3 21412011

Date of Visit: �jrb— Arrival Time: DO Departure Time: County: Regio��_
Farm Name_ I �t�✓iyiy�.}�rs� _ Owner Email:
Owner Name: j~`tnrr-i. U.>�,r Phone:
Mailing Address:
Physical Address:
Facility Contact: ts IT," V1 c � d1S6 - Title: t4 �'� Phone: /
Onsite Representative: A--4— Integrator: Aicp '�_
Certified Operator: Certification Number: pJsJ
Back-up Operator: 7S,,, , Certification Number: q
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current _ 1Design C►urrent
Swine Capacity Pap.
. ,
W61,
et PoaltryCapactty ;P,op Cattle Capacity Pop.
_
Wean to Finish
La er airy Cow
Non -La er Da' Calf
can to Feeder
Feeder to Finish,!
� Z� _ DairyHeifer
Farrow to Wean
Des -Mt ent Dry Cow
Farrow to Feeder
D. . PRRI . Ca `aci Po- . Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Beef Feeder
Boarsllets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[—]Yes [il Tio ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection -
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r 91 s
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
JZ 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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ 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
L3 Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E2�.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 Drib ❑ Application Outside of Approved Area
12. Crop TYpe(s): _ /Y'tr VDl.e; /
13. Soil Type(s): 19
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
Reauired Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Lg No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Jallo ❑ 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 Eff.,j+10
❑ 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
DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

i
Facili Number: - Date of inspection. 0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®,No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5a_No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes RNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jallo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes [�],No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes Q .No
❑ Yes EZkNo
❑ Yes L21-No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Coinments (refer to question # ). Explain any YES answers and/or any additional recommendations or any other comments.
Use drawiinias of facility t-o better explain situations (use additional vales as necessarv).
?, r-- ;-,t. Lam- s cam" �� .� l�,� o�- ��F I J'-"-
/-ybo�'�4 t-i9ok- /�_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �`�y�`"3�'�
Date:
21412011

.. w 5-larle
Type of Visit: 1$ Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 9 Routine Q Complaint 0 Follow-up Q Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: ; p CountyS, Region: P
r�
Farm Name: R� -g F(,m
Owner Name: �ipnn&h W 6W
Owner Email:
Phone:
Mailing Address:
Physical Address: gSol � P(ypke P
Facility Contact: KPn vS Title: �Mt'1} Phone:
Onsite Representative: C��r"S Integrator:
Certified Operator: kieonQ+A W, t qs
Back-up Operator: Chris 0, Bass
Location of Farm:
Latitude:
Certification Number: I$ 3,S j
Certification Number:
Longitude:
Design Current3Dtgn
Current
Design Current
Swine Capacity Pap.et PoWt 1? �ty
Pap.
Cattle Capacity Pop.
a
Wean to Finish Layer
Dairy Cow
Dairy Calf
Wean to Feeder
$
5—
Non -La er
I
' ""
Dairy Heifer
Feeder to Finish
Farrow to Wean
De_ sign
Dry Cow
Farrow to Feeder
D : yP,oW Ca aci Po
Non -Dairy
La ers
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
on -Layers
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 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
rR No
❑ NA
❑ NE
❑ Yes
®'No
❑ NA
[] NE
Page 1 of 3
i
21412011 Continued

Facility Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ER 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): qrs
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
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [>_� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑A_p`plication Outside of Approved Area
12. Crop Type(s): CA01 ,h&vLJ0... 6c - RNOIe-. Soadll d/ lb I'lir�9'fft
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 12 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 12 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JR 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 U No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
aNA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J�j 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 [RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej 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
151 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CRNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
® Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #.): Explain any YES answers and/or any additional recommendations or any other comments ,}�
Use drawings of facility to.better explain situations (use. additional; pages as
n
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q -4300
Date:
21412011

Facility: No. aFarm Name. Date
r
Permit ✓ CrQC'�j OIC�z� NPDES(Rainbreaker PLAT Annual Ceft Daily. Pipe }
FB Drons
"�•��
nn
1_ PA
r - - • • _ • - •
----®
FRIMMSM-
_ • • • - • • - a1
--5--®®
r , •-----
Soil Test Date
�?'-
Crop Yield
Transfer Sheets
PH Fields � - � �
F
Wettable Acres ✓
RAIN GAUGE
Lime Needed;
WUP
Dead box or incinerator
Lime Applied ;
Weekly Freeboard/
Mortality Records
Cu-I Zn-
1140;I Q.
1 in Inspections '�^
Check Lists
Needs S (S-1425) ; '
120 min Insp. �^
Storm Water
Needs P ! I =° ! < w "
Weather Cnrles -�
111
Verify PHONE NUMBERS!and affixations Y • ' - - - --- -- --.�.,i"8''
Date last WUP FRO 'T i �r*qY FRO or Farm Records iao
Date last WUP at farm Lagoon # on
App. Hardware Top Dikea5s-
t Stop Pump I '3 -7 3Its-
Start Pump alE4„
Conversion- Cu-1 30oo �108 lb/ac; Zn-I 3000= 213 Ib/ac
f'
M

If ype of visit: tV Compliance inspection V Operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: O Routine O Complaint (5) Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: ��//� Arrival Time: } Departure Time: County: Region: M
Farm Name: Reaj F1im
Owner Name: ��nn
Mailing Address:
Owner Email:
Phone:
Physical Address: _q5a q p0j1}kp 41
Facility Contact: 60.1n. AaffTitle: J:�rvr r�r Phone:
Onsite Representative: Ve A AV Integrator: G
Certified Operator: _Kern "h �j O Sj Certitication Number: I'S351
Back-upOperator: too
P �j/+�_c Q1�_ Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Ca aci Po w eta' -
§ oul _
P ty p• try .
Non -Layer
,. , .
Dry Poult ;l ;:
De la
�
m P h'
Design
Ca aci..
CPo ent
P•
Current
P,o ,
- Design C ►urrent
Cattle Ga aci Po
p t3' P-
Dairy Cow
Dairy Calf
DairyHeifer
Dry Cow
Nori-Dairy
Wean to FinishLayer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
,..
Qther
Turke s
Turkey Poults
Other
FTOther
Discharees and Stream Impacts
l . Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: g - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ej 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?
❑Ycs
®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
[,�Z 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
2'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ej 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
b�j No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
g NE
maintenance or improvement?
I l_ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
❑ No
❑ NA
10 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, 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 Callo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA RINE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
RNE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
❑ No
❑ NA
W NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
[] NA
NE
the appropriate box.
WUP ❑Checklists [-]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No
❑ NA F�ej NE
❑ Weather Code
Sludge Survey
❑ NA ❑ NE
ZNA ❑ NE
Page 2 of 21412011 Continued

Faeili Number: a - 4.
Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ No ❑ NA � NE
❑ No ❑ NA C�kNE
❑ 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 .0 -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No K[ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[] Yes CR No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes [n No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA aNE
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
[r No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
J�rNo
❑ NA
❑ NE
�� �� ks half. ` 0 sn,i 1 �
Oki EPPAL. , Good rk . �lann P,
Isar s reao� n ks, Sir
on idha.2 nm�s�ro
°�
EIVs yyn jan-e ("i -iUn-e/ �utr� V J �Iit� lXl r
Reviewer/Inspector Name:
Phone: 910—g 7 7-c iI1C��CP�
Reviewer/Inspector Signature: �'1 -In aq Schnp )p^ Date:
Page 3 of 3 42011

. JVS 61MS 51asha'
Type of Visit: (SMompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (WRoutine O Complaint 0 Follow-up O Referral O Emergency p Other 0 Denied Access
Date of Visit: I5W1j5J Arrival Time: Departure Time: County: Region: rklo
Farm Name: Kenny f`Q//*'/ Owner Email:
Owner Name: I` naJ3 to Phone:
Mailing Address:
Physical Address: it ti RQonoke PA _
Facility Contact: Vnnx Title: D�/�� Phone: 570L2.'o
Onsite Representatives Integrator: N- B
Certified Operator: t-e n nfll 8o fj
Back-up Operator: b T Bail
Location of Farm:
Latitude:
Certification Number: j�? 3S
Certification Number: )8307
Longitude:
esignCurrent-
Design *Cu eitt " '
�IDesignFD
M
apacity
l?op.
Wet Poultry
LCapac tty Pp` _@attle
Capacity
Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
:-
`
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
1? . P.oul
Ca aci
,Po .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
O#her
Turkey Poults
Other
LiOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes CS'No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes to No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FaciIit y Number: - a Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [>-I 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): — ] q, 5 Observed Freeboard Freeboard (in): �}
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes Ca No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
1. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): COAT I0411AQ fla-A P004P_ .SMQll diV i 1
� � v
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
[_]NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
Ca 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
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall inspections
❑ Sludge
Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[g No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�aNA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Ins ection; al It
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1�0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [>__� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility tail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[] No
aNA
❑ NE
[:]Yes
D? No
❑ NA
❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes 5? No ❑ NA ❑ NE
❑ Yes E(No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
CKYes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES"ansKeiri2and/or any additional recommenda.hons'many other. comments. I
Usee drawtnas4of•facility to better explain situahons'(use{adtli[tonal naizes as necessarv).
sofl
u' V iJ
JCA-
cmrneed s�lf'�r•
Sbil { saw ee
i1r) C,CC1
y r�Do/ V
s v�ve yy,, ai c.
D wL -Fp �i1Pc� �uv� c Pr � ,� y I31 11a .
.�1
3� P 5
� �cor � a I� ��� 1
o r 1._j
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
_ aoo,i Schny�,°,
Phone: q/0- Y-A-2 330j)
Date: a l
412011.

. . .
Facility No3a -d a 1 Farm Name �ellmf 6Q-) Date
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
WON .1r, rATITS62 MIN.
Lagoon flame, S forspillway
1
2
3
4
5
6
i
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of co iancel POA?
4-1
Ring Size (in)
Design Flow (gpm�-
Soil Test Date A90
Crop Yield Nab//
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
Lime Applied
I C t-
I M. WUP
b-Weekly Freeboard
Dead box or incinerator
Mortality Records
Cu-1 Zn-
5 1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P 0
Weather Codes
Waste Date
- 60 Da
+ 60 Day
lqq
S91
N (lb11000 Gal)
I. r7
I. U
I,�:,
►7iTAIIICWiGl�if FFl=*dL,#r!
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
44,
30
a
P
a.
o
s�
Verify PHONE NUMBERS nd affiliations
Date last WUP FRO 31) a IQS FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardwares Top Dike
7-� pe5}w2- Stop Pump
Z0� I � J ya H200=
_ ft Start Pump
Conversion- Cu-, 108 Ib/ac; Zn-I 3000= 213 Iblac

• "'" Quality cacili
ty Number ga - as Q Division ofe5oil and Water Conservation
Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Gleason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 6W 1 Arrival Time: Departure Time: County: SL�itYl,f%y�
Farm Name: �� Par Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: ys;) y Roalae Q_ vfkl bt 61(p„p
Region: [
Facility Contact: r(-e Title: Owner Phone:
Onsite Representative: 9Z Integrator:
Certified Operator: I(fryVV' Bau Certification Number: Pga,j.j
Back-up Operator: cArl'A D, PC Certification Number: )73L49
Location of Farm:
Latitude:
Longitude:
Depsi im U. nt'?�r
gDesi
Cp rent
Swine
Ca aci Po Wet P,oult
ty A
Capacity
CP p
Cattl Capac�'ty op.
Wean to Finish
La er
Da` Cow
Wean to Feeder]Non-Layer
Da' Calf
Feeder to Finish
'`'
Da' Heifer
Farrow to Wean
'r"'
Design
Current -;
Dry Cow
Farrow to Feeder
rt D .foul Ca aci Po
Non -Dairy
Farrow to Finish
' Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
a Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
[]Yes No
[:]Yes D�fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - as Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JZ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ai-).
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ 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
No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Wo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [54'No ❑ NA 0 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):
PI
13. Soil Type(s): 'FaC:tAp ±L I ELL _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes " No [_]NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CgNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[::]Yes
P4No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
ErNo
❑ 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
�U No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
16 NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: $2K - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cff 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
Cy NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
LaiNo
❑ 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
CqNo
❑ 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
t;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
5TNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ 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
O�No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other coiliidienfs.
Ose`dcawings of facility to better explain situations (use additional pages as necessary):
�a ���I✓ i 1nM �� �' �J ���
U v i ks. The 04 f f_ imkr k)
ca�S/V e-, r ) t��Q[/� (Q�✓Cfl.Fof POAdndf /& On
aSS �d 6'�rV �x u a `f •
% r ,rat 4� c&H Cal .
Sp �rG� 3 col
�%
d
� oS JC e- fV ��,
� Y�
eorf
Falrnr II ij cxdVo fe
as nAd a beve, &radJ ae � �s1 ye.
V
Reviewer/Inspector Name: _JQQqSrhn�tor-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 17"33 � _CfQ
Date: D Dell/
2/4/2UII

`Facility No31-Coc
a F rm Name )ff4 Date
Permit OIC NPDES (Rainbreaker
oil
In' 11�.Y7�1lirRa•
�uilLJisJ
PLAT Annual Cert)
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Surve Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Z 5,At � n .
Calibration Date
1$ i
2
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Actual Width
um"- q4.) mk*l ./
Soil Test Date j�
pH Fields
U 0 , T/OIC
Wettable Acres RAIN GAUGE
WUP Dead box or incinerator
Lime Needed
Lime Applod
t
Weekly Freeboard Mortality Records
1 in Inspections
Cu-1 ✓ Zn
904r
120 min Insp.
Needs P �J
Weather Code
Crop Yield v
Transfer Sheets >1 FL —
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt (lb11000 Gal)
L
f .
PulllField
Soil
Cro
Acres
PAN
Window
Max Rate
Max Amt
c
300
1,
a
(r-
a
Is G
o-wy-
�k
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farmg) Q�
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 iblac; Zn-1 3000= 213 Iblac
App. Hardware
So 10 3ei--
I
1�s
J

0 Division of Water Quality
jpacilityNumber Ua as O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit (�r Compliance Inspection
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit
tR Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency 0 Other
❑ Denied Access
Date of Visit:
Arrival Time: r� Departure Time: Q : (} County:
RT IF
Region: tko
Farm Narne: ICBM
RIPRIP47
Owner Email:
Owner Name: 12
n4 elb
_ f _ Phone:
Mailing Address:
`53
&eu eHIM
Pd wi 610!�
�
Physical Address:
Facility Contact: Title: 0 Wier Phone No:
Onsite Representative: yy��,�,, Integrator: H—!a
��Certified Operator: _n,W Uu3f Operator Certification Number:
Back-up Operator: _tl � �� �• LI Back-up Certification Number: W3
Location of Farm: Latitude: ❑ o ❑ f = Longitude: = 0 0
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
❑ La er
d D 1-77 S'j ID Non -Laver
Dry Poultry
Non-L
Pullets
Turke-,
Poults
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

F
Facility Number: —ail Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N 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?:
Desigrted Freeboard (in): ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ief large trees, severe erosion, seepage, etc.) Yes No [I NA El NE
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 5aNo ❑ 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 tR No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes t@ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ERNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes TRNo ❑ 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. jJ61 :�` Pi�rt ,dA (ff&/q-r6)'hj/� 1 t
13.
" l
Soil type(s) t, e_
14.
Do the receiving crops differ from those designated in the CAWMP?
[]Yes
$0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
EU No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J4 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
[:]Yes
'KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Reviewer/Inspector Name E—; ` SC Phone 9mI 433 3333
Reviewer/inspector Signature: jZPjJL Date: of
Irma 2 of 3 U 12128104 Continued

Facility Number. Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes lj� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
1P NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
S�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
$allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J;a No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
15[NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CKNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 yes
R'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C�-No
❑ NA
❑ NE
f yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
EZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
yCKNo
LJ No
❑ NA
❑ NE
AdditibnaWomment`s and/or Drawings:
Vieo� Yvork ol 1900, Cof&_ 01 bacle Ide ) AYide-5-
a} , �. a sr� d ye solve do, e 1, oc-t a oog fixer f*m L)� j a o � y d u � -b hip ) rq�r'�
-lea-66e t Vol"e.
q,$Wh'er roh in iof & dayf
Very 3M, mc(ds .
)V® 5fa(t9 d&e_lojf rimer.
Page 3 of 3 12128104

Facility No. a— a Farm Name
Permit ✓ COC
Pop.
Type
Design
Current
%PAnr Date 1ILI
OIC� NPDES (Rainbreaker PLAT Annual Cert }
�--Milli���
_..z
20- 1 —
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date It,
jp
Sludge Depth (ft)!,
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
��►0�- -�i�►„ Sltdsn SJty�r r� � �0��( —CL� r� IF�C•o-f— �t�{. a alo th+`F�.Fh
Design Flow
Design Width
Soil Test Date ya h Q
pH Fields
Lime Needed 0,-7TIQr ��3
Lime Applied
Cu-I ✓ Zn-I ✓
Needs P
Crop Yield
Wettable Acres ✓
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
W C
RAIN GAUGE
Dead box or incinerator
Mortality Records
Bather odes
Transfer Sheets Wa-+e&y 11i3` 100-31-711f)-A*,0,5P0iAd
Waste Analysis Date
.f .-
. fig Ga
1
i
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
!
$ ,3
f,
r
-
50
.S Hav
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon # la Jay,
Top Dike ?
Stop Pump d Q5
'15
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac [9.0
S P* qa S 1
rf

Type of Visit 15 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: f Region: Flf
Farm Name: Owner Email:
Owner Name: W H,111
� - BQSs Phone:
2 h!ne1i l-1 Mailing Address: f [+ 1 ru_ _ Nevfo,� 66--e_zug2
Physical Address:
Facility Contact: f enry Ba.B7 Title: 01,4Phone No:
Onsite Representative: �1ox Integrator: 4jqh'f-&o ✓n
Certified Operator: K n / 1 ]as Operator Certification Number: AM 12M --
Back-up Operator:Bag _ Back-up Certification Number: AVA �g3y I
Location: of Farm: Latitude: [= e 0 d= Longitude: Q o=
Design Current
Swine Capacity Population
llesign Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder
3
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turke s
10 Turkey Pouets
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Fecder
❑ Farrow to Finish
Giits
PE113oars
- -
't e
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
1�?No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
-71
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
9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: $a — 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 l Stnicture 2 Structure 3 Structure 4
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 6
Identifier:
Spillway?.
Designed Freeboard fin): _q,S
Observed Freeboard {in): D�,
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
Q�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?
tZ Yes
❑ No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
r*No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
N No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Callo
❑ 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 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 types) 117✓Q � f DA' ! s 6 0
13. Soil type(s) Fay'lle,F
-�S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tR No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
D Yes
1)--,�No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
tgNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P�FNo
❑ 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 _apAw . SC1 u E 1 ePL Phone: Clio 22-331!01C333
Reviewer/Inspector Signature: Date: 3 Doc)
k,! 12/281U4 Continued

Facility Number: hate of Inspection r�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IR No ❑ NA ❑ NE
the appropiate box. ❑ w1JP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ElYes No El NA El 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?
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?
jAdditional Comments and/or Drawings:
❑ Yes
W No
❑ NA -
❑ NE
[--]Yes
❑ No
DNA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes ❑ No [)JNA ❑ NE
❑ Yes nNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
PK—No
❑ NA
❑ NE
Ca York c, b(.e sro,
bads►de c I a, �vo) ,
s `rlrrd [u �a`�l nerxr; f - &"Jer.
wf(ba �h 1 I a ,var*!sf acrrrsi0170 ,
Plod ue� rlai�l� � �hol-w y y
as r Exfm - vn s,l �d e s-V�j aoo�: w�' I 1 o'le 1/1
r' wi b9e n*tr', Sao/D,
'7rrfc71 +7� iQ�'fi n hl, p%nni�y-4o f arf as- soap err (feldrol/a��
OWy a i I ref [ I ma Ibia -fOr/7' 04aC ,g'Xd r/1,
IZ2&"

Facility No. ?_IFarm Name k(>A130)Date
Permit `f COC � 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& %
Liquid Trt. Zone ft
/4
Calibration Date
11�1a-xkT
2
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date St
pH Fields �
Lime Needed & hA-6e J
Lime Applied ,/
Cu �/ Zn
Needs P
Crop Yield
a 6 �� ,Wettable Acres
rwd# WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incKerator
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Arnt
QB
300
3 -to
40
to
'S-10/
Verify PHONE NUMBERP and affiliations
Date last WUP FRO S l4 $ Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike S30-
Stop Pump
Start Pump SiS
3k r
exa ss
MV7�
App. and are
� s
-501
picrivn-W I a 5

4 _ ,ti
a�
b�-
p�, -.3�1 - -, ira&d
��-rr �o wfW-- bob
SSd�b�- Q413�b1� ��n6f'
Us -50(

_ - -3vs v rms '3 laala -- - -- -
Type of Visit 19 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 45Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: — '� — Departure Time: Q, r
n 30 County: � Region:
Farm Name: A i3 .S t7iM Owner Email:
Owner Name: 1 _ Bo 2S _ ,_ Phone:
Mailing Address: 159 66AI P sl fw' 6(erg
Physical Address:
Facility Contact: k Title: Q ew Phone No:
Onsite Representative:
Certified Operator: k!!n11
Back-up Operator:
Integrator:
Operator Certification Number: S t
Back-up Certification Number:
Location of Farm: Latitude: = e = I ="
Longitude: = ° = I 0 u
gat
Design xCurren#
Swine C�pac�ty Pupation
Finish
Design CdrrenTt
Wet PooltryC pacity Prop 11 ton
❑ La er
Design Current
Cattle Capa ty Population
❑ DairyCow
Feeder
❑Non -La er
❑ DairyCalf
El to Finish
El 7�
KFed
to Wean
Feeder
Finish
R rY
Other ' � 6
❑ Other
rtto
k....a`'to
aers ❑Non -La ersPullets❑Beef
❑ Turkeys
❑ TurkeyPoults
❑ Other
Feeder
I
❑ Beef Brood Cod
- -
Number of Structures:
❑ Dairy Heifer
❑ D Caw
❑ Non -Dairy
❑ Beef Stocker
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
P No
❑ NA
❑ NE
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: a -aa Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ERNo ❑ 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): Icf. 57
Observed Freeboard (in): Z as
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes O 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 C'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? 19Yes ❑ 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
1R[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?
IL . Is there evidence of incorrect application? I f yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑: of Wind Drift ❑ Application Outside of Area
�Evidence
12. Crop type(s) P(M ✓d-&- �F7�r1 s t�s
r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
N No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
0'No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0 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
RNo
❑ NA ❑ NE
Reviewer/inspector Name SC I Phone(g10)433-�jDk3333
Reviewer/Inspector Signature: Date: a
Page 2 of 3 V 12128104 Continued

Facility Number: $ —c� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. [] WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JR 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
5a 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
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1.9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CR NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1.51No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
19 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
13 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
AddittonaliCommen. aadJor-Drawings
-7 La`yoo>� cDu�r i s ) ooki o0 Or
0 i a� Wall , i4hei s i--fi` y
Pleve- c I i i barb a� o�,de ,��.
�vS
R, pl&hni� IUD 40 Sol � fol arm In fa If a-vC I,' n , EPCold opfa&: )n lW& POAme
a y . Ca I, b�al�e�C a o0-1. W 111 recrx [T braf� �� n�o^ 1v�e 4-A n ew j `��°i''®rfi ins I14
Q5, >Exemff f�oM sI4 je swve W-fi 1 aooq, Phe6e do tYe- aft I- yev,-
WII Vert Paton 4 records,
PleoeMall Cc(j $toIc-cwA 4o PRO— Acwol &m$0°y
a
Page 3 of 3 12128104

Facility No. Farm Name
Permit COC ✓
Date
OIC NPDES(Rainbreaker
PLAT Annual Cert )
Freeboard
1
2
3
4
5
6
7
Design
RIMS
Observed in
Sludge. urvey Date Perm Liquid ft
,t
N1010107 Sludge Depth f#
'*- EX6xrfw w I a.009
-Calibration Date
Soil Test Date 101al
pH Fields t154 S
Lime Needed 1110%
Cu �� Zn ./
Needs P
Crop Yield
Wettable Acres
WUP
Rain Gauge _
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections ^�
Weather Codes
Transfer Sheets
Waste Analysis Date
Soil Test Date 101al
pH Fields t154 S
Lime Needed 1110%
Cu �� Zn ./
Needs P
Crop Yield
Wettable Acres
WUP
Rain Gauge _
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections ^�
Weather Codes
Transfer Sheets
Waste Analysis Date
M�MMM
• 1 r _
M77jr�MRMMIFM7A'
rrr
L • w- • r
�Ilr •
' Ii
A* t� '
but
�Pvrc
:1 1

Type o€ Visit I*.Compllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit & Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 5 Arrival Time: Departure Time: = County: Region:
t 7 /2 w I
Farm Name: T
Owner Name:
Mailing Address: ^„
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 1
Owner Email:
Phone:
Title: n,)fcy, Phone No:
Integrator: 1/2_wh► r (/y� I S
yy Operator Certification Number:
Back-up Operator: �b Back-up Certification Number: ! 0 J 9
Location of Farm: Latitude: E:] o E:] ' E:] Longitude: = ° LL
Design Current Design Current
Swine C►apacity Population Wet Poultry Capacity Population C++able
00-0
sign Current
Capacity Population
❑ Wean to Finish
❑ Layer
Dairy Cow
can to Feeder
Zv
0
❑ Non -Layer ❑ DairyCalf
❑ Dairy Heifer
Dry Poultry ❑ Pry —Cow
ElLaEl
❑ La ers
❑ Beef Stocker
❑ Non -Layers
❑ Pullets ❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
❑ Yes
[] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[9 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P 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
51NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
­-K�NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection !l
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 J] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
❑ No ❑ 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?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
)�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) '&M �l
i G , '�ym G r Q / S
13. Soil type(s) FQ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N°No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate'per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ru' No
❑ NA
❑ NE
Comments (refer to question #)�: Explain any YES aniwers andtor any recommendaiions or,aay other comments
Use drawings of facility to better explain situations.: fuse additional pages as necessary):. r
w
Reviewer/inspector Name UhTl Mt_ W( AJ f Phone: to W
Reviewerllnspector Signature: Date:
rage 2 qj s 12128104 Continued

Facility Number: — Date of Inspection Il►/ J /o I 1
Required Records & Documents 7
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )in No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 09 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
VfNo
❑ 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
%No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
UNo
❑ 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�3 No
❑ NA
❑ NE
E x u-1 6.� ftczrds .
�J: "J � N'Y�y r fV_1
Page 3 of 3 12128104

Facility No.0 f�� Time In
Farm Nnmo
Owner
Operate
Back-uF
COC
Time Out ate 11/� '
Integrator CJ, 7rr i
Site Rep
No.
No. 3
'DES
Design
Current
Design
Current
Wean —
Farrow —Feed
can — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey ✓ G`�
Crop Yield
Rain Gauge
Soil Test A dlettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
ate Nitrogen (N)
Observed
Calibration/GPM /
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
C) 4
Pull/Field Soil Crop Pan Window
UP1

I r1F_F_,_.,
Type of Visit Com ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: j f �fn1 p[p� Arrival Time: t Q Departure Time: County Region: r�
Farm Name: e'n- Pox 'mS Owner Email:
Owner Name -f v,ks q o s� (� � S �3
Phone:
Mailing Address:
Physical Address:
Facility Contact: _ Title: trt1Wr Phone No:
r-Z r
Onsite Representatii
Certified Operator:
Back-up Operator:
v 3S Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I = Longitude: 0 0 0 A = u
0A rn Fie., N c% 1i0-5 (U" Rd-o,�, �s�o�CQ � S�.!(o�io EZ�� Lt A
Design Curren
4 Design
Current Design Current
Swine Capacity Populathon
etJPoultry Capacity
Pop'Ulation Csttley Capacity Population
❑ Dai Cow
to Finish
❑ La er
to Feeder
3Z0
❑Non -La er
❑Dai Calf
Dai Heifer
D Cow
r to Finish
w to Wean
Dry Poultr❑
""'
._❑ Non -Dairy
w to Feeder
La ers
Non -La ers
Pullets❑
FrIF,e
w to Finish
❑ Beef Stocker
Beef Feeder
❑ Beef Brood CoAjTurke
s ❑ Turke Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
[-]Yes �ZNo ❑ NA ❑ NE
❑ Yes
❑ No
UNA
❑ NE
❑ Yes
❑ No
ANA
❑ NE
�#NA
❑ NE
❑ Yes
❑ No
❑ Yes
5%No
❑ NA
❑ NE
❑ Yes
RVo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 7 Oip
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes IN 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): .I
Observed Freeboard (in): 5 .3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ViNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes '#PNo
❑ 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 `(io
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes IoNo
❑ 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 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )A_No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes_J�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'foNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �Wo
❑ 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 'F;No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'RNo
❑ NA
❑ NE
Comments {refer to question # Explain any YES answers and/or any recommendations or any other comments
Use drawings'of facility to better explain'situations. (use additional pages as necessary).
Reviewer/inspector Name
Phone: _ ''
Reviewer/Inspector Signature: r� Date: cI tt//6 ��o
Page 2 of 3 12/28/f� Continued

. Facility Number: — Date of Inspection l l
Required Records & Documents j
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 [INE
the appropriate box,
ElWUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
UIo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
7-NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
JENA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
WA
❑ 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
DNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑ Yes
O No
❑ NA
❑ NE
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
ANo
❑ NA
❑ NE
Additional Comments and/or Dawings:
`Egpl Je4l ro rm
f ?ecDr�, ee.P� n ; rt Op r� G� o✓Cy�J►'
U �
ro-em anal ov"01.F, — V wcll .
C�
Page 3 of 3 12128,104

Facility Number 1 Date Time IN 16so Out
Owner
t�l1�«Ll �IS1ai4 i ��/r��.
C.O.C. Gen NPDS
Dehg Current Design Current
Wean to Finish Wean to Feeder
Feeder to Finish Farrow to Wean
Farrow to Feeder Farrow to Finish
Gilts Boars
Other'_
Soil types _ 0. i46
Crop Types 1� Pan _360 Window - V(k
---
0256
Soil Test 5'_/a ulo Plat �J I A
Designed Freeboard 1 Z I- 7 /-z_ Observed Freeboard
Rain gauge Rain breaker Daily Rainfall Waste Transfers
Calibration of spray equipment G.P.M.
i A0
Sludge Survey Crop Yield 120 Minute inspections
1 in. Rain inspections Weather code Weekly Freeboard
Pumping time -zo
Waste Analysis % & Month
I )
Comments
3Qw

I
Type of Visit 49 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: o'x ' y O S Arrival Time: 'S/o Departure Time: County: .Saftgsm-7 Region: FRO
Farm Name: %%nm� ae ss /��r..� Owner Email:
Owner Name: —eel fs Phone: `T7lO_ S9Y- /oo�
Mailing Address: 3s fb, GroY
Physical Address:
Facility Contact: ke-g , „ Boss _ Title:
Onsite Representative: _he,,, _► qA!s
Certified Operator: Me t t elj(.
Back-up Operator. CA e-,s _.iQaSS
Location of Farm:
Phone No: 710- S-?O- `1r!2
Integrator. for e-j"j'ym . 1602vra'0-ot/
Operator Certification Number: _.1$.351
Back-up Certification Number: 1.R3 Hj _
Latitude: = o ❑ 5 ❑ " Longitude: ❑ ° ❑ 1 = u
Design Current Desigu Current
Swine Capacity Population Wet Poultry Capacity Population
U'Re-an. to Finish SOD
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I
Other
❑ Other
❑ La er,
❑ Non -La et i
Dry.Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current:
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daiary Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Coca
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures '�EL
�.
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 L2No ❑ NA ❑ NE
❑ Yes
[<o
❑ NA
❑ NE
❑ Yes
B'go-
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑ Yes
,ErNo
L� No
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 1 ;2 -
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 l Structure 2 . Structure 3 Structure 4
❑ Yes �o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3AjA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ql�o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) !!
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2 o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Q Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9`No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
0 yeso
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EWo
❑ NA ❑ NE
maintenance/improvement?
I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
5�<o
❑ 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
300 9 1-15-
12. Crop type(s) r�lw�..a�ik ha... S,r� n �� CC In n
13. Soil type(s) ar
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?
[I Yes
E] No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
Yes
2<q
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El"No
ElNA ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA ❑ NE
711Ert Qr[ arras srF eroyrh d4 0.410 100 00 P1 A4AT /Kra Qws$ /0/441yl 40/
forsal zsu arJa/ Svti oJra►ss Sr+na� >*u Pr�w..f C.cs.'y .
IS. Mr. dasf A&,r an oil � e.i�' �a '� �+�awrt /e/•h 1t. f '/1 �1, sa..✓ /�eie/ b�/� �slrs
Reviewer/Inspector Name j /���, r B / S` Phone: 4/0- S'8G -/s, We,**'>3o
Reviewer/Inspector Signature: Date: �2 -
1228104 Continued

Facility Number: S.� — Dale of Inspection - -�
Required 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 Lr No ❑ NA ❑ NE
the appropirate box. ❑ Ww,- ❑ C fists ❑ D gn ❑ �eaK ❑ 9*f
21. Does record keeping need improvement? If yes. check the appropriate box below. EQIes El No ❑ NA El NE
� t i
r�_ to- s
� El
EIS El WftTa, El Aa��on
P<ainfall ❑ O<op Yield [ O Minute Inspections �onthly and V Rain Inspections ❑ V44e4terCrude
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
3 1 . Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (fie/ discharge. freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a ibllow-up visit by same agency?
❑ Yes
2-1�o
❑ NA
❑ NE
❑ Yes
❑ No
G-NA
❑ NE
D,nes
❑ No
❑ NA
❑ NE
❑ Yes
G,56
❑ NA
❑ NE
❑ Yes
-Iqb
❑ NA
❑ NE
❑ Yes
❑ No
9-A
❑ NE
❑ Yes ©-Ko ❑ NA ❑ NE
❑ Yes D-iClo ❑ NA ❑ NE
❑ Yes [+- <o ❑ NA ❑ NE
❑ Yes [;-o ❑ NA ❑ NE
❑ Yes Q'�io ❑ NA ❑ NE
❑ Yes 9-15o ❑ NA ❑ NE
Additional Comments and/or Drawings:
;twed Lrv,00 Ys/C/ For.,s, Plecost n4'c� r-""6//
Tdr ri7p�f� y
1 s t�rrle tv, i-A 6e s p ktn„rd
1+ G.�o� f0er�a�nrt�q L4�:L,Q,�a� h J e
waje a'Pr /'r
12128104

Facility Number Date of Visit: � Time: O
Not
,,���� Operational Belnw Threshnld
C.TPermitted Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: &-,5 hip. ► County: S�aw+PSor►
Owner Name: kle-"n 9QS& .,Ph_fone No: 110 -� +- 1OOg
Mailing Address: 3S9 _lfowsc 1►'1;1j Rd_ /�w�ort ynm f 14e-
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: �in S Operator Certification Number: %f
Location of Farm:
LKSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 9 - Longitude ' C�• ��
Design Current Design Current Design Current
Swin Ca acity Population Poultry Capacity Population Cattle Ca acitV Population
%can to Feeder 15S.20 ifA I JE3 Laver I ❑ Dairy I I __j
El Feeder to Finish ❑Ikon -Laver ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow- to Finish Total Design Capacity
Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present j❑ Lagoon Area J❑ Spriiv Field Area
HoldingPonds / Solid Traps T g '
p ❑ No Liquid Waste Management System _
Discharges 8 Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharge orimnated at: ❑ Laeoon ❑ Spray Field ❑ Other
a. ifdischar_e is observed, was the conveyance man-made?
b. If discharge is obsen ed, did it reach Water of the State? (If yes, notify' DWQ)
c. If discharge is observed. what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
?. Is there evidence of past discharge from any pats of the operation?
3. Were there am, adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 3 Structure 3 Structure 4
Identifier:
Freeboard (inches): 333 -SA*
05IV3101
❑ Yes 2 1vo
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes Ua<qo
❑ Yes [2<o
❑ Yes GKo
Structure 5 Structure 6
Continued

Facility Number: ff i — 221
Date of Inspection / O
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffets that need maintcnancelimprovement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type j r,;
B. Do the receiving crops dAr with thos esignated 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?
Reauired_Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes IJ No
❑ Yes LKNo
❑ Yes L__P' oo
[R
❑ Yes o
❑ Yes 12<1
❑ Yes I`1No
❑ Yes 19
❑ Yes M o
❑ Yes UTgo
❑ Yes UKO
❑ Yes �o
❑ Yes [9. <oo
ElYes Lld'�o
❑ Yes Q44o
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,,. -
tCommens refer to gaesbvn #I) Explam any, YES.."siWdf nddor. anyfrecommendatlom 0 _ anV othe , mments.
Userdra of facib to
wings better ea larn�st tuattons"
e h �p (useiaddtgonal pagesasnecessary) field Copy El Final Notes
w aM4rty` u
far., kt15 OO 8ftc, (le+;P,- Om 0,4. e'T i1c4n N�SLS �t OTt a++d r �= r�Q6S A" SA; d
�
II Ake. ��ii
R Sr
�WIJ LC h� �+Cd i✓i` ,, Wek. IL' S wrS. a rcc" 14 a`{' ` k W w; ��" �4sY c.>rCC.
Cod ram.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: V— ZI Date of inspection D3 R
Odor issues
26. 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?
27_ Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a p'crmanent/temporary cover?
MP. ► AW,It Lbras Flo 1. 1ti �d . erdcr /VCC vot;f
❑ Yes [Pt o-
❑ Yes
❑ Yes EPiv-'
❑ Yes 21q-o
❑ Yes �o
❑ Yes 0;44u—
❑ Yes fo
O510310I

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
149 Routine 0 Complaint 0 Follow-up (if DNV0 inspection 0 Follow-up of DSWC review 0 Other I
Facility Number
[3 Registered M Certified D Applied for Permit [3 Permitted
Date of Inspection
Time of Inspection 17d I.1 1 24 hr. (hh:mrn)
1[3 Not O cratj�(jnal Date Last Operated: ..........................
FarmName . .............. ... m., lon.� ....... County:......... ..................... .......................
Owner Name: .............
'... ".. -a 3 .. I ........... Is. ".S ............................................................. Phone No . ................ 51*/Ppy .........................................
Facility Contact: �P.m Phone No: ....................................................
..D&WA ... . ................ ..... Title:.
MailingAddress:.-. ........ ....... ..... .. P.r ................................. ...... ...........
Onsite Representative:.... ......................... .......................... Integrator: ........ I ........................ ........................
Certified Operator, .......................
Location of Farm.
.............. I-- .... I—- ... 11.... Operator Certification Number..
Latitude a 9 ic Longitude & .4
, Design Current Design ..Current . Mtig*,._ ,Ciiri-ent.1
Capacity, Population Poultry Capacity Population Cattle Capacity Aulation,,,
0 Wean to Feeder
Feeder to Finish
ZSAO
Itt #S t7
❑ Farrow to Wean
0 Farrow to Feeder
El Farrow to Finish
,0 Gilts
Q Boars
JE1 Layer
LP Non -Layer I I
I0 Dairy
I[] Non -Dairy❑ Other
Total Design Capacity
Total SSLW
10 ©spray 'N ifiber of Lagoons / Holding Ponds JE1 Subsurface Drains Presenty Field Area
_j�agoon Area
J - ONo Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
L_
Discharge orif?inatcd at: El Lagoon [I Spray Field El Other
a. If'discharge is observed. was the conveyance man-made'!
b. 11-di.,charae is observed. did it reach Surface Water? (If yes. notify DWQ)
c. If dischai-_,e is observed, what is the estimated flow in YaUrnin"
d. Does discharge . c bypass lagoon sy stein? (it: yes. notify
DW(1)
3, Is there evidence of past discharge from any part of the operation?
Z
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes XNo
El Yes brNo
0 Yes M.No
El Yes ElNo
❑ Yes $9 No
❑ Yes EM No
El Yes WNo
❑ Yes No
❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
El Yes Wo
Continued on back

Site Requires Immediate Attention:
Facility No. — -�,
D1vISION OFFNVIRONTIME 'AL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: W , 1995
� r
Time:
Farm Namz/Owner:
-V D 14\ 1q j 1�a nrt \4 30ISS
Mailing Address: 3 5G NOOSeS 1 Mi11 la a n'P-UJVor�
County: SQnn Sv'n
Integrator: 7 Phone: 51Q -S -v
On Site Representative: o" Phone: 10- 5 _ p
Physical AddresvLocation: S R. w.2fw 70
t
Type of Operation: Swine Fin. Poultry Cattie
Design Capacity: �88a X? ;�/F�n. Number of Animals on Site: $� ►e _
DELM Cittification Number: ACE DEM Certification Ns mber. ACNEW
Latitude: r ' iD _" L ongicude: ._' .23
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: 6�tw Inch
Was any seepage observed from the lagoon(s)? Yes or N Was any erosion observed? Yes of
Is adequate land available for spray? &er No Is the coven crop adequate? _'es r No
Crop(s) being utilized: _ - 1 . "-- _—
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 'c or No
100 Feet from Wells? ' se or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or IQ
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or CO)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management ;�g
(volumes of manure, land appliedspray irrigated on specific acreage with cover crop)r No j
Additional Comments: .�. -M — /
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

All =L VELST'S IGL=G=I=T PLAH CSR`=FXCATIQN MR N39K OR
APR I91"4 f
P1040e rstn,= the completed foxes to the Division of at L.
the add=sse on the zaverss side of th=p fog.
Name of fares (Please prTintr kr.vJj '�4F �c
Address: R-' . Z 1V c �l+�.l � ¢.%J!S
Q Z !.
MTR QGTUTY
V &A=
Phone No.: 45�-lUO�
County
iasrz location; Latitude and Longitude: �S aq � /?d=z�' (requixed) . Also,
please attach a copy of a county road map with location identified.
Type of operation (swine. layer, dairy, etc.) -
Design capacity (number of animals) =aa7+ dG.A
Average size of operation-(12 month population avg.):
Average acreage needed for land application of waste (acres): o
sr.::s:asses aasasasraasfaaarasaaaassaaa a ssaa:aidasaa�a�r aaa aeasasasa=aaa rsaasassaaasa
T-Chaical Specialist C&rtificat3oa
As a technical specialist designated by the North Carolina Soil and Water
Consecration Commission pursuant to ISA NCAC 677 .00OS, I certify that the new or
expanded animal waste management system as installed for the farm named above
has an animal waste management plan that mests the design. construction.
operation and maintenance standards and specifications of,the Division of
Environmental management and the USDA -Soil Consecration Service and/or the North
Carolina Soil and water Conservation Commission pursuant to 15A NCAC 2H.0217 and
ISA NCAC 6r .0001-.0005. The following a'levents and their corresponding minimum
iteria-haAmm.been verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; -adequate
quantity and amount of land for waste utilization (or use of third party) ; access
or ownership of proper waste application equipment; sc-hedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stozmwater runoff events less severe than the 25-yeas, 24-hour
storm. -
Xams of Tec.saical SDecia3 st (Please, nrUnt) Al.K1V &A,
Affiliation:
Address (A4esicy) 3o3- D� Y�,u1cLR GI:J s•l t1.[ Phone No.
Ze3Zg
Signature • hu h, Date • 2 -
asaaysasaaaasasas� s as ��yraaraa=aaaaaassaasaa�a:na=rasa:aaasaaa=aa�asrs
oWLAr /'_L'A aqe=
I •(we) understand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures. I (we) know that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked_ I (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25-Year, 24-hour storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Naas of La-d
Owner (Please Print) ,
Signature: Date: '• '
:Taal of Ka -agar, if different from owner (Please print) :
Signature: Date -
Note: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
r"•,nviror ner_tal Management witi2in 60 days of a title transfer.
DEK USE ONLY:AC?JaW*

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N6
k-
IWJE-CARE-
WE USE
Fims
CLEAN AIR
R gA
FARMS
V -