820251_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
2 'N

z
Type of Visit: om Lance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: I Arrival Time: b; 60 Departure Time: Di y 0 jUounty:,9/j41j'R6 IV Region:
Farm Name: O b`u t N r� iu t S � Owner Email:
Owner Name: ocA.� ��� u e4^ Phone:
Mailing Address:
Physical Address:
Facility Contact:w i �6-c/ G> Title:
Onsite Representative: t(
Certified Operator: 4—, o,�, , C 0 14 e�-
Back-up Operator:
Phone:
Integrator:
Integrator: `/ / "C e
Certification Number:cC_ L ff b
Certification Number:
Location of Farm: Latitude: Longitude:
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 [[ 'No ❑ NA ❑ NE
❑ Yes ❑ No Q-n'f' ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
L, -J NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Design Curren#
Design
Current
Design Current
NA
Swine
Capacity Pop..
Wet Poultry
Capacity
Pup.
Cattle Capacity Pop.
Wean to Finish
❑ Yes
La er
❑ NA
❑ NE
of the State other than from a discharge?
aig Cow
Wean to Feeder
'L 6 Oct
er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
..en
jDry Cow
Farrow to Feeder
D , P,oult
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
10ther
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 [[ 'No ❑ NA ❑ NE
❑ Yes ❑ No Q-n'f' ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
L, -J NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
®No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
®No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/1015 Continued

i
acilit •Number: - Q -S Date of Inspection: 77 �-[
Waste Collection & Treatment
4. rs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a_ If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): �bk
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[-Ni'[] NA ❑ NE
❑ No L!,` A ❑ NE
Structure 6
E] Yes EDXo- 0 N ONE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [3'No ❑ NA ❑ NE
waste management or closure plan?
❑ Yes
B`No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
['110
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
acres determination?
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
[] Yes
[j -?4-o
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L2 -<o
[:DNA
❑ NE
maintenance or improvement?
❑ NE
Required Records & Documents
Waste Application
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
k2,1Qo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
the appropriate box.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 E]Application Outside of Approved Area
12. Crop Type(s): C cs - P Sf
13. Soil Type(s): t",& chi `A lr y
14. Do the receiving crops differ from those designated i4e CAWMP?
❑ Yes
B`No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
Ig -"'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
[j -?4-o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D,>6
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
k2,1Qo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
L 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 o [-]NA [:]NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [L?No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili .Number: - I S 1 Date of Ins ection: J U `t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes *No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ErNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes U3'-N'o ❑ 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 E30'No ❑ NA ❑ NE
❑ Yes [a N ❑ NA ❑ NE
❑ Yes U]11�o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No
❑ Yes
❑ Yes
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Ccz, f, 6Tw-�I �- 7
c �(( I r o- 3 0 8-0 5 I
Reviewer/Inspector Name: i t1 0 U
Reviewer/Inspector Signature:
Page 3 of 3
Phones? . 3 `'3,3V
Date: J j u..
2/4/2015

GL Number 2 S O�DivisionFof' _
Water Resources M1
tY� -. - � �' � `� Soil artd VlWater Consen�ation -.
Q Othe�Agency
Type of Visit:Com liance Inspection 0Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,3J Departure Time: / if County:
Farm Name: 0 �i�[s aL-t 54mcte—_ Owner Email:
Owner Name: O(AIC-y` Phone:
Mailing Address:
Physical Address:
Facility Contact: (� Title:
Onsite Representative:
Certified Operator: L -[a yia�j o f t� rc/
Back-up Operator:
Location of Farm:
Latitude:
S lft Region f __6 0
Phone:
Integrator: tM tY�
Certification Number: t, (, J 7 0
Certification Number:
capacur + uN.= -
-- - - -- - -
Wean to Finish Layerx.
❑ No
Wean to Feeder ,� • 6v Non -La er.
❑ NE
Feeder to Finish i
Farrow to WeanDesign _Current -
Farrow to Feeder D , Rou41trI.Capacity::` Pop..:
Farrow to Finish La ers
NA
Gilts Non -Layers
=
Boars I 1pullets
Poults
Other l ! Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes o ❑ NA ❑ NE
[] Yes
❑ No
D—NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If ves. notify DWR) [:]Yes ❑No NA [:]NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rNo
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters El Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilii`'umber: - 5 Date of Inspection: 16 wff
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
D -Mo' ❑ NA ❑ NE
❑No ©"11�A E] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): d2 Z
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 property addressed and/or managed through a
waste management or closure plan?
❑ Yes [3'N10 ❑ NA ❑ NE
❑ Yes [2<o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments rest, 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 [3-io ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E3<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EYNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes L_tl No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydra-ulic 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): �� S� G
13. Soil Type(s): (-JeL U. -K q4 Vle
14.
Do the receiving crops differ from those designated in tie CAWMP?
❑ Yes
❑-No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Ej o
❑ 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
[] N
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[JKo'
❑ NA
❑ NE
Required
19.
Records & Documents
Did the facility fail to have the Cenificate of Coverage & Permit readily available?
❑ Yes
Io
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 -No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists F-1 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 F] 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 0NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
[:]Yes g5No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Facility ,dumber: &7-- ejCj I Date of Inspection: 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12<0 ❑ 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 Er< ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ONo
❑ 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
CTNo
❑ 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
0"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
�o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E3 o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E3<o
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Lf
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
( C -iia f- `k5
6 � `1 / Phonelf G —q33– 3 3 W
re: Date:
M24 12
214120;5

jType of Visit: EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
(Reason for Visit: GHl'outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �J Arrival Time. Departure Time: County:
Farm Name: p t�V t/1 1 ifqOwner Email:
Owner Name: -� A f-[� Phone:
Mailing Address:
Physical Address:
Facility Contact:
S
Onsite Representative: �(
Certified Operator: �� ��... �� t✓�
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Region: [_%_D_
_
Integrator: AL
5
Certification Number: 1219 0 W
Certification Number:
Longitude:
Design Current
❑ NE
Design
Gnrrent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
]Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P.ou1
Ca aci
I'o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turke s
er
rFC
TurkePoults
r
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p 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 No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes [::]No
❑ Yes E!rNo
❑ Yes gNo
NA ❑ NE
[a VA ❑NE
❑ NA
❑ NE
❑NA
❑NE
[:INA
❑ NE
Page I of 3 2/4/2015 Continued

Facility Numb T jDate of Ins ection: YJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [Bodo [DNA ❑ NE
Structure t 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? Cl Yes, o ❑ 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 EYNo ❑ 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 d ❑ 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 �N,o ❑ 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 E3/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): 8 eg_ 's-60
13. Soil Type(s): �L I
14. Do the receiving crops differ from those designated in the C WMP?
❑ Yes
EaXo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[RI<o
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
CfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Cj"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ o
0 NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[TNo
❑ NA
❑ NE
the appropriate box.
❑ WUP F-3 Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ��'�No ❑ NA ❑ NE
F-1WasteApplication ❑ Weekly Freeboard ❑ Waste Analysis E]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 dNo ❑ NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

Facility Number: -5h jDate of Inspection:
24. Did theiacility fail to calibrate waste application equipment as required by the permit? ❑ Yes to ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes DKo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a AOA 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 [�Joo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ Io ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [310 ❑ 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 [24o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo ❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additionalpages as necessary).
C"a 4,
s("s)e sq -r -t (�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L
Phone: " _3i 3y
Date:
2/4/2011

type or visit: U Compliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 6 Departure Time: County: c�ti� Region:
Farm Name: C�,ti �� C�S�4
Owner Email:
Owner Name: C) I L"rA Phone:
Mailing Address:
Physical Address: I
Facility Contact: Cl/A 5 �x� 41� Title:
Onsite Representative: It
Certified Operator: Z"'—_'j 01ttg',
Back-up Operator:
Location of Farm:
Latitude:
Phoney
Integrator: �( >
Certification Number:(
Certification Number:
Longitude:
Discharges 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 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 *6 NE
[:]Yes ❑No
[:]Yes [:]No
�NE
❑NE
❑ Yes
❑ No
Dest n Current
g
Desi
gn
Design Current
❑ NA
Swine
Capacity Pop.
Wet Poultry
�Current
Capacity+l'op Cattle Capacity Pop.
❑ NE
k,. - .
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Feeder to Finish
b
Non -La er
- -� �
Da" Calf
DaiHeifer
Farrow to Wean
Design , Curre"
D Cow
Farrow to Feeder
D . P�ault ,
Ga aCi .�
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
I ITurkeys
ON
9M
f
Beef Feeder
Beef Brood Cow
-_
Other
s:
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:
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 *6 NE
[:]Yes ❑No
[:]Yes [:]No
�NE
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
�No
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - 71 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZjNa---ffJ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Yes
Identifier:
NA
❑ NE
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in):
❑ NA
❑ NE
Required Records & Documents
5. Are there any immediate threats to the i--ntegrity of any of the structures observed?
❑ Yes
E�.
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[ leo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 46 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
[D -'"o
❑ 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
Dqo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [A-E ❑ 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/Siudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): eg G✓ S Zsm_�;.) n
13. Soil
Type(s):62 V. [_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3 --Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
©-M
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EJ'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E],N-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 ❑.leo
❑ 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 [l]'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
C-] NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facili Number: JDate of Inspection:
Ir
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes "" ❑ NA D NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [NS ❑ NA D 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 G -go [:] NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes Q -Mo D 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 [D -Na ❑ NA E3NE
[-]Yes L_f "'o ❑ NA ❑ NE
❑ Yes E]-lq-o [] NA I—] NE
[] Yes []-No ❑ NA [—] NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E3 -'go
DNA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Yes [3 -No
D NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [2 No
[DNA
D NE
mments refer to nestton Ex tarn any YES answandlor any additional recommendations oranyotherco '" 'e
V
drawuigs.of facility to 6efter.explain situations°'{use..addihonal pages as necessary).,
�?e
Slvs�'�_ 50r,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r 1
Date: -2a �a
2/412014

aM rAs
Type of Visit: B'Com i nce Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: URoutine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: County: (/�P Region:
Farm Name: D (ate- Na_t Owner Email:
Owner Name: Le -4-7 i, L� `� Phone:
Mailing Address:
Physical Address:
Facility Contact: { C _
Title:
Phone:
Onsite Representative:
-
Design Currents` Design Current
Design Current
Integrator:
Capacity PopWet�Poultry''} Capacity Pop -
Certified Operator:
�0>/�.y�
T) 6 UE -4—
Certification Number:
Wean to Finish
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
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)
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 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
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes C3'No
❑ Yes [i -No
�®NA ❑NE
�_T
L KAK ❑ NE
�TA
-
Design Currents` Design Current
Design Current
Swine
Capacity PopWet�Poultry''} Capacity Pop -
Cattle Capacity P.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
k `.
Dai Heifer
Farrow to Wean
Design Current .•
D Cow
Farrow to Feeder
#' DruyjPoult Ga aei F,o , __
Non -Dairy
Farrow to Finish
Layers r
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r Turkeys
Other
;*; Turkey Poults
11 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)
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 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
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes C3'No
❑ Yes [i -No
�®NA ❑NE
�_T
L KAK ❑ NE
�TA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

oil
Facility Number: V- Dateof Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
I__I To ❑ NA ❑ NE
0 N 0 N 0 N
Structure 5 Structure 6
❑ Yes 044Vd ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[_'V V ❑ NA
E]NE
waste management or closure plan?
Soil Type(s): Q& c
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
ob,bLo' ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0>)--ONA
❑ NE
maintenance or improvement?
Waste Application
❑ Yes
ERIN
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F;f oo ❑ NA
❑ NE
maintenance or improvement?
❑ NE
Required Records & Documents
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �i ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): e(f 67 CJ
13.
Soil Type(s): Q& c
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rC i<
❑ 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
[TN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ERIN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z Ko
❑ 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'? ❑ YesfZo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Awn :z
Facility Number: - Date of Ins ectio
24. Di&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
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -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 ReviewerAnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
ca�'( � 6 '_ '�" 0,-,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
r7 t -1 -
�nl ❑ NA ❑ NE
❑,.No ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes [3-Nz— ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes ©'No ❑ NA ❑ NE
❑ Yes r"No ❑ NA ❑ NE
❑ Yes [ -11;ro
❑ Yes [�o
❑ Yes C9 No
Phone:
Date
❑ NA
❑ NA
❑ NA
a J
21412011
❑ NE
❑ NE
❑ NE

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qlfooutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: JI 'lel Departure Time: County:
Farm Name: Owner Email:
Owner Name: o d �rfi Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: 1��1�/�„� Title: ��f Phone:
Onsite Representative: �,��� Integrator:
Certified Operator: L arty Certification Number: kv5
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes Q No ❑ NA ❑ NE
[–]Yes ❑No
[–]Yes ❑No
❑NA ❑NE
❑NA ❑NE
❑ Yes
Design Current
Design
Current
Design Current
qNo
Swine ;.
Capacity Pop.
Wet Poultry Capacity
Pop.;
Cattle x �'�Capacity Pap.
❑ NE
Wean to Finish
[Dairy Cow
Wean to Feeder
Non -La er I
Calf
Feeder to Finish
Vis'
,= Des
D Poult Ca aci
Layers
”
Current
Po . '
I
—Dairy
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers ers
Beef Feeder
Boars Pullets
lBeef Brood Cow
Turkeys
Fx
Other €y
,Turkey Poults
Other
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes Q No ❑ NA ❑ NE
[–]Yes ❑No
[–]Yes ❑No
❑NA ❑NE
❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
2/412011 Continued

WacilitY Number: Date of ins ection: —J
�
(Z No
❑ NA
0 NE
Waste Collection & Treatment
❑ Yes
[A No
❑ NA
❑ NE
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
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E�No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in): /91
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[gNo
❑ NA
Observed Freeboard (in): 1,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[MNo
❑ 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
23:jNo
❑ 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
L&No
❑ NA
❑ NE
8. Do any of the structures 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
� No
❑ NA
0, NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [§rlo ❑ 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): rOvr/l:r�
13. Soil Type(s): G(l';P ! ��'�� Y --
i
14. Do the receiving crop iffier from those designated in the CAWMP?
❑ Yes
(Z No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A 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
[E�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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 [g.,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E ,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2!�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 2/4/2011 Continued

acili Number: 22 - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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?
S
Reviewer/Inspector Name:
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
[—]Yes EK No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes M No
❑ Yes HLNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Phone: 2�69_ —!Z 73 _3_`�
Reviewer/lnspector Signature: Date: /
Page 3 of 3 2/412011

Type of Visit:Ce�oLLmpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Oloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: �$ Departure Time: County: .v,! n Region:
Farm Name: �ti�t24�U{�S ��� Owner Email:
Owner Name: 9 nKgl' �N. MMVr, 9. Phone:
Mailing Address:
Physical Address:
n
Facility Contact: LvRg "�1S L� _ Title:
Onsite Representative:
Certified Operator:Wp1Oy" oywy-
Sack-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: %Rav:>(3
Certification Number: `C,' '-st,
Certification Number:
Longitude:
Design Current
"`
Design
Current
.Al
Design Current
Swine -;°� Capacity Pop.
V4'et Poultry
Capacity
Pop.
Cattle Capacity Pop.
We to Finish
Layer
Dai Cow
to Feeder
Non -La er
Dai Calf
to Finish
Dairy Heifer
Farrow to Wean
-
Design
Current
Dry Cow
Farrow to Feeder
" Dr-Poultr.
Ca_ a�ity
P,o ,
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
IPUIlets
Beef Brood Cow
R
Turke s
_
Qther
Turke Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [{] No ❑ NA ❑ NE
❑ Yes
❑ No
Ea"NA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
i
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ) ❑ Yes [:]No A ❑ NE
?. Is there evidence of a past discharge from any part of the operation? ❑ Yes Cno ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes 2No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

IFaciUty Number: - Date of Inspection: L{ 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [SKo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑No [YNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _*3 -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes eNo ❑ 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 MNo ❑ 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 treed maintenance or improvement? ❑ Yes [3SJo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [R]14o ❑ 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 [3No ❑ NA ❑ NE
maintenance or improvement?
Waste Application 01
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q 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 [3No [] NA ❑ NE
❑ Yes Ef No [] NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ['No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ea No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes E✓f No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspect7�No
22. Did the facility fail to install and maintain a rain gauge? [:]Yes
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
dNA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili h`umber: - Date of Inspection: f4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [+1No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [yNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ff 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'? Ifyes, check the appropriate box below.
p 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 [TNo ❑ NA ❑ NE
❑ Yes EDNo ❑ NA ❑ NE
❑ Yes [i]' No ❑ NA ❑ NE
❑ Yes [D'No ❑ NA ❑ NE
❑ Yes [�JINo
[—]Yes [D/No
[] Yes C�Ao
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Review crl[nSpector Signature:_ Date:
Page 3 of 3 2/4/2011

Antis ?/islzGv �
(Type of Visit: 0 -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: S County: Region: / 'lo
Farm Name: t,c Owner Email:
Owner Name: {-�- 12- , Q i tx - Phone:
Mailing Address:
Physical Address:
Facility Contact: o.t,t ftt5 Title: Phone:
Onsite Representative: 'rj Integrator: f Ab .
Certified Operator: 9I &Lw- Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
iDesrgn Current*,
1'
e -Capacity Pop.
M
inish W
DesignCurent
WetyPoultry Capaciiy= Pp
FRLa er
Design Current
Cattle Gspaeity Pop.
Dai Cow
eeder q�
Non -La er
Dai Calf
Finish
„ ,,i"'
Dai Heifer
Wean=kms,
fft
Design Current
D Cow
Feeder
D foul w:rye � Ca acr Po
Non -Dairy
Finish
Layers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
;.... ,
Otherf.*_-
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)
❑ Yes [ 'J ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[R --<A ❑ NE
03KA 0 N
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 R A ❑ NE
2. Is there evidence of a past discharge from any pari of the operation'? [::]Yes Q'oo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes io ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: �-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g3<oEj NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �❑ 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 []'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
[0-<o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
E] No
[] NA
❑ NE
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[lNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D.4f6_
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[g -<o
❑ NA
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
D -W
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
to
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes [2 -KV- ❑ 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 D❑�Ewiden e of Wind Drift ❑Application Outside of Approved Area
12. Crop Type(s): rtiuiriG� �V U��Ct-V{� , S-6-0
13. Soil Type(s): LA -4 t5 ;
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ©'110 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2-1 o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E 'No
DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E] No
[] NA
❑ NE
Required Records & Documents
19. Did facility
the fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check
❑ Yes
[g -<o
❑ NA
❑ NE
the appropriate box.
❑WUP E] Checklists ❑Design [:]Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �fo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [3 Yes I]"lvo ❑ NAA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No El -3<A ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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 [ o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes O Ko
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 [D No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes D�o
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 B' o
❑ Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ©'No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes [ o
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E31fqo
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
,eA.Lse_3S\.-P—
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA t[ -1E
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ONE
E] NA ❑NE
C] NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
er,,4k
w,4
P
��k ids �N �� � I.
Phone: 1/0 T 4—D �y I
Date: lZ l
21;,112011

Type of visit 'WCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: SOV0151 Region:
Farm Name: Owner Email:
L ,,
Owner Name: h-49"- 0 1 ("V-19'- Phone:
Mailing Address:
Physical Address:
Facility Contact: elVf* ( Title:
Onsite Representative: )riG
Certified Operator: RD bet
Back-up Operator:
Phone No: 3 85-- ) 4016
Integrator: 1
Operator Certification Number: lg3g1
Back-up Certification Number:
Location of Farm: Latitude: =0
=d =6. Longitude: = ° = I = u
WCaP,_Popjagn
Current,
Design Current Design Current
Swinety
x .
utiotf `'Vet Poultry
Capacity Population -: Cattle Capacity Population
❑ Wean to Finish
a. Was the conveyance man-made?
❑ Layer
❑ No
❑ NA
❑ Dairy Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Wean to Feeder
%�D
10 Non-Layer—L Non -Layer -L
EINE
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Dairy Calf
❑ Feeder to Finish
" "
�q
[:1 Dairy Heifer
❑ Farrow to Wean
D_ ry Poultry
1:1D Cow
El Farrow to Feeder
2. Is there evidence of a past discharge from any part of the operation?
_ ❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
_
❑ Turkeys
Outer
❑ Other
El Turkey Poults
El Other
Number of Structures: O
Continued
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
EINE
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
I'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
WYes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number. �L_ —a Date of Inspection Eflulw
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IRNo ❑ NA EINE
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): X7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes PRNo [INA ❑NE
❑ Yes NkNo ❑ NA EINE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environnl�nt� Beat, notify DWQ
7. Do any of the structures need maintenance or improvement`? EqYcceTTs VV o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ER�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E"No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes r*No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[)_tNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Reviewer/Inspector Name �� Phone: —
ReviewerlInspector Signature: Date:
- -.r ^f -sr 1 !')/'79//1.4 !'....r:...,.,.1
. �6 J

Facility Number: 00a — Date of Inspection 0 i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WM P readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EZNo
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
E,NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
FK1No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EINA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ 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
VTVo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[;JNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;'No
❑ NA
❑ NE
Additioh' iCommeitts andl Dr: wings: `
3� Pr a) impact-- Cows have, act ess +D snnaI t � P1
P1,6evcxk aq bae_5fot� oll lojur wall nery p" r,
6 ks h o ue_ecce t pit coves (-
, R%ge. it, 00C * j s cvo//A+
a
at, plebes 111 l'asof e)d &'SP�c7 , S I son kJ aP 1 a6,
t�
a9 way c+�h"a �1�e d opt sir �► Woq A-14 Doo Ja a )lis
1p, o"Od—
�X
�} , y& I"VI
Fly it
r
T
Page 3 of 3 12/28/04

Facility No. 'D"a�Farm Name
Permit COC
Pop. Design Current
Type
t{il#- A/vIls-01 Date
01C� NPDES (Rainbreaker PLAT Annual Cert )
41fl, WHENM=
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
-Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
Design Width
Soil Test Date { a00aJ Wettable Acres RAIN GAUGE
pH Fields WUP ✓ Dead box or incinerator
Lime Needed Weekly Freeboard � Mortality Records
Lime Applied 1 a 1 in Inspections
Cu -1 Zn -I ✓ 120 min Insp.
Needs P _0 Weather Codes
Crop Yield jakransfer Sheets
N Amt (lb/1000 Gal) ff6l
iJt!� [I�i►7��;
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
ki 1 4, -P 1.0
aw to S i
Verify PHONE NUMBERS and affiliations
Date last WUP FRO -713401 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 Iblac
App. Hardware y! J f
sl `c — 10�
10 -� /0,0
Sot��s�
hj�
Lt

'Pliq s /Z- 7--Z- - zoo 9
Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ClRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r3• Departure Time: County: �o3"v�✓_ Region:
Farm Name: VIiY*--Y Nays- ee tk Owner Email:
Owner Name: )eo6zv% D/ ✓?_!r Phone:
Mailing Address:
Physical Address:
Facility Contact: '(len/AJ t?44 40/1',Jw Title: O&JAIWIS - Phone No:
Onsite Representative: Z614,4_ 01' ✓W 04"lw Integrator:
Certified Operator: 6�+'� /,wW Operator Certification Number: l
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=t
=it Longitude: = o = L =A[
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
E]Yes
[B -710[I
Design Current
CrrentCurrentacity
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Papulation
Wet Poultry Capaciopulation
TP
Cattle Capacity Piijopulation
❑ Wean to Finish
❑ Layer I
❑ Dairy Cow
Wean to Feeder 0 00 1110
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish f I
❑ Yes
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowi
❑ Yes
El Turkeys
❑ NA
Other
❑Other
❑ Turkey Poults
❑ I
Number Structures:
_�]*o
Other
of
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
E]Yes
[B -710[I
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
El Yes
El No
��
Eg A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0<A'
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
,
LAVA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2 o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
_�]*o
12/28/04
Continued

Facility Number: 1002 —2S/
iz-�r o9
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
Identifier: Gu 4 1
Spillway?: /✓D
Designed Freeboard (in): / 9
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 1•J No ❑ NA ❑ NE
❑ Yes [ €o ' ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [TK -o__ ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETgo— ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 8—No— ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CI No ❑ NA ❑ 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 Area
12. Crop type(s) PU�.4ra—dam ( ra;-e- ld, Sj
,
13. Soil type(s) GeiGtlg C11%T1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�l,<o ❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L7No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ YesIo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [ NNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2 No ❑ NA ❑ NE
Comments (refer to ques#qu #):Explain any YES. answers hndlor.'any,rec6rumendatioris o'r any other cnFnM" ents.o '
Use drawings of facility to better explain situations. (use additional:
pages as necessary):
Reviewerlinspector Name L
Reviewer/inspector Signature:
S
Phone:
Date: /Z — !S— 204 9'
11128104 Continued

iz -�s =off
Facility Number: gZ —2S1) Date of Inspection
Rmuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 8<0' ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3< ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps n Desig p [:1 Other ,_.
21. Does record keeping need improvement? If yes, check the appropriate box below. [3 Yes E_, 'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O,No
[INA,
ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
Ng�o
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,L—'l,,
t�'r�o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2 o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes U o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ffrNo ❑ 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
El Yes
_ ,�
2No ❑ 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
o
L��"N❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
[:1 Yes
Ej<❑ NA
❑ NE
Comments and/or Drawings:
12/28104

Zr H Z
Type of Visit &fornpliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ra1 Arrival Time: Departure Time: County. Region.
Farm Name: ©\.! V­P_f ` Owner Email:
��%Owner Name: A O1li i4" Phone:
Mailing Address:
Physical Address:
Facility Contact: `-'f C�kTitle: El rey- Phone No:
Onsite Representative: `i O��I`� Integrator:
Certified Operator: 1 tS ry-Y Operator Certification Nu r:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o =6
0if Longitude: =11=1 = u
Swine
❑ Wean to Finish
Design Current
Capacity Population
Wet Poultry
❑ La er
Design Current
CMpaciMty Ph lotion
N Design Current
Cattle Capacity Population
❑ Dairy Cow
Wean to Feeder
❑Non -La er
a. Was the conveyance man-made?
❑ Dairy Calf
[--]Feeder to Finish
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
: , _
❑ Dairy Heifer
❑Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
J29�jNA
❑ NE
[I Non -Dairy
❑ Farrow to Finish
❑ NA
❑ Layers
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Beef Stocker
❑ Gilts
❑ NE
❑ Non -Layers
El Beef Feeder
❑ Boars
Page I of 3
El Pullets
Continued
10 Beef Brood Ca
❑ Turke s
❑ Turkey Points
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes eII'@ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
kv NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes ❑ No�ZNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?--I—
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Yes El
J29�jNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes Q 'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes JKJNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility. Number: -2si
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?
StVcture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes,f3No [INA EINE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo ElNA [:1NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes gNo [INA [INE
maintenance or improvement? v
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ANo ❑ 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 ❑ Applica ion Outside of Area
12. Crop type(s) C r S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the,CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J�No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes _jp 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 ZNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any; recommendations or any other comments ".
Use drawtngs.uf facility'to better explain situations. (use additional pages as necessary): A
Reviewer/Inspector Name ST` Phone: 3
Reviewer/Inspector Signature: Date: kjpj i_
Page 2 of 3 12/28/04 Continued

Facility Number: �L— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NNo ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UIo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
jo NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
U(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[A NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1<1 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ YesNo
A
[:1NA
[:1NE
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
ElNA
El NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
10 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional: Comments an"r: Drawtngs:
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Facility No. 1 Time In Time Out D to
Farm Name Q v-2 Integrator =
Owner _ �j 5�1\8L-,)-A Site Rep
Operator `.-��� U1 No.
Back-up
�DCOC
M
C' e' feral or NPDES
Design Current
Design__ Current
�Finish
Farrow --FeedWean
—
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey y l``
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard '✓ Daily Rainfall
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Observed
Calibration/GPM
Waste Trans
Rain Breaker
' l �P•COLO
PLAT 11
1 -in Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
-� r

Type of Visit ®Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit® Routine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: Countya
Farm Name: ((� j Owner Email:
Owner Name: 2C)6_v `c. Q Vt V'41>V Phone: _
Mailing Address:
Physical Address
Region:
Facility Contact: - Title: 0 u3ney Phone No:
Onsite Representative: OJI Integrator: �.
Certified Operato 0/ Operator Certification Number: 3�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 e [=' [__1 Longitude: = ° = I 0 "
iii Design Gurrent
Swine Capaa Population
❑ Wean to Finish
Wet Poul ry
❑ La er
Design Current
&apac�ty pulation
Design Current
Cattle Capacity Population
❑ Dairy Cow
ean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
rVt`
`"
El Dairy Heifer
E] Farrow to Wean
s
Dry Poultry
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dry Cow
❑ Farrow to Feeder
[] NA
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ No
El Beef Feeder
F] Boars
El Pullets
❑ Yes
❑ Beef Brood Co
'
❑ Turkeys
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Other ,r�:.�r.�
❑Turke Poults
❑ NE
other than from a discharge?
❑ Other
❑Other
Nurn !oft Structures:01
Page 1 of 3
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes J!kNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'QNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
b§ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: a5 Date of Inspection ? d {o
Waste CoUection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
14
a. If yes, is waste level into the structural freeboard? ❑ Yes )Z No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in): i
Observed Freeboard (in): C� r
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes'14,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 Oto ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes -$,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) t Q"Mu& ;;�M G-' Q{
13. Soil type(s) k-,kja.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes gl�4o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[] Yes 177 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes )$No
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
-
Use drawings of facility to better explain sitnations. (use additional pages.as necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
}. N
Date:
12/28/04 Continued

Facility Number:Ta Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes bd No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check []Yes A No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design [:1 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes
JZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
KNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
]RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1%No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
&INA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Cl Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal`?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�4 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
fid'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
OR No
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
El),
Yes
� No
❑ NA
❑ NE
Additional Comments and/or Drawings '.k:fi ,.,
w �
iJo� c -- 1�- -1 41,4. a n e L (�K 1 t ,n UL '(M rnor -,Jcw- .
a
L� '2w C' vtn- �- r e i,n a co'. Cr OR S�0.$bri
Page 3 of 3 12/28/04

9Facility No. Time In� Time Out _ Date �l
Farm Name Integrator
Owner vex Site Rep
Operator Ck + No. �Q
Back-up No. _
COC Circle:eneral or NPDES
Design Current
Design Current
Wean — e (0
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design 1
Sludge Survey t
Observed
Calibration/GPM 1 !
1�
Crop Yield Waste Transfers
1 —
Rain Gauge ✓ r, .1 P k Rain Breaker
Soil Test PLAT
Weekly Freeboard Daily Rainfall L.--
Spray/Freeboard
Weather Codes �_ 120 min Inspections
Waste Analysis: ?
Date Nitrogen (N)
to {o OU
<6
Wettable Acres
1 -in Inspections L/
Ilzt—i12o
Date Nitrogen (N)
n a
Pull/Field Soil Crop Pan Window
U S �
kah
J-
/�o

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: [ ] Arrival Time: e O Departure Time: County: Scc.�oson Region:
Farm Name: v Owner Email:
Owner Name: go I,,I Phone: C!/D- -921 � r/72
Mailing Address: ��'/S3 JVo.^i-1's &Z 6e,, lee, J NC a85��j
Physical Address:
Facility Contact: Mrs. t:i.' P Title.
Onsite Representative:
ke,mes'A
Phone No: %a- al+/- -iLys-2
Integrator: yr 4 / �-
Certified Operator: /faker _/.'err Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: F --I o [� 4 ❑ Longitude: = o =1,
❑
Design' Current Design Current. Design Current
Swine Capacity Population' Wet Poultry Capacity Population Cattle Capacity Papulation ', '
❑ Wean to Finish
DJ-G4ean to Feeder pp
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish s
❑ Gilts
❑ Boars
Other
❑ Other ,
❑ La er
i ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife3
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoAj
Number of,Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9 -go ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[r Fso
❑ NA
❑ NE
❑ Yes
L'_f<
❑ NA
❑ NE
12128/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ -Ko ❑ 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?: �7p
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q�Ko ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ED -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? Egfes 0'Fo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
O'1Go ❑ 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
PNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D lffo ❑ NA
❑ NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑-�res
❑ No ❑ NA
❑ NE
❑ Excessive Ponding E 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 Drill ❑ Application Outside of Area
Sa 1.¢ ��'7q� !Q — 0q/
12. Croptype(s)
� — -" 6.-1
-7ma/1 it%u.'' DVer< Al `aVlure
---
13. Soil type(s) ����p , w,��►
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O'f10 ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
QNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
❑ No ❑ NA
CSE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA
[Q -KE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Qilo' ❑ NA
❑ NE
'Comments (refer to question #}; EAiWn any YES answers and/or ahy recommendations or any other,comments.
Use drawings of facility to better eapisiin, situations. (use additionaLpages as necessary)-
1 0" 5mui/ Ade
l/ Plus' See /a,T -lode
Reviewer/Inspector Name I �
Reviewer/Inspector Signature:
mrt 1 A;.e1 pa,] e,
Phone:
Date: !1-
12/28104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
E? es
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Ealres
❑ No
❑ NA
❑ NE
the appropirate box. ❑ Wy`� EJ Che sts D'besign EJMa s/❑ 90,rer
21. Does record keeping need improvement? If yes, check the appropriate box below.
�-
'Y es
[--]No
❑ NA
❑ NE
Lf _e 6'4..2 , 3 P -/g 7 /, fJ 1�?-10 ->J.q-
[20%,—,/aste Application �eekly Freeboard ❑ ❑ Soil Analysis ❑
❑
❑ Rtnnf64 ❑.S4ee64+g CKrop Yield [2<20 Minute Inspections ❑
ED -Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O'1Qo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
Eg-A
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
9—lgE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[�i14E
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
21sIE
27. Did the facility fail to secure a phosphorus loss assessment (PIAT) certification?
❑ Yes
❑ No
❑ NA
[3'1fE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2"INo
❑ 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
D -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
[lNo
❑ 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
[?' 4o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
1 -res
❑ No
❑ NA
❑ NE
Addtttiin ftic hments acid/or Urawings.1
1cf, s/orcfvr- W 11 ,�,u,� a Gari the ne ,. uj�
c o vera9c F
7U. 4r4lo ecla,, u„ 1/ Orr Qne� �.'n!/ Lc C C"""' 04 f 4e 1G5 o e des''3 n.
4., dc p
r vrmS
Usc CrUp s O� f�,r FRQ 0,'.5 P/eus 6e Svrt
Av
e Ac/
ver /. O Mt,AV4e IP/
p /easF
e keelo tveek/ rP
e 4darU/ leve /S Ori r
Tory, S, �fQ our•
�ns/oslf,�r rev,'ru.rol /pe v wus+�e l� I I q 1
p� e Qs de
•Fd use f-�e 44 N.{rove., 2oL f o., -SRR �or✓++6 , p/euSP be eaeel l
►eon �o u /uVer
r. r'
rr yu�"0n even 12128104
On 3-/J vS a., r,{ y-� os` 31� y�f ga//Orn5 Gvete
T n slocc{Ur w.'1! Per�arm et lo//Cl— 7ro v, -s; { hoe, is ass%f in ferard kee,-;,,61,

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date or Visit: Tune:
Q Not O ratioual O Below Threshold
[Permitted ErCertified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ......_—•-• --
Farm Name: County: ... ...?i+'
Owner Name: ------ hoePr ��.�.......�/ Phone No:
-
�2...._.........
Mailing Address:...1 �/�3 Na �L,.i ... �0.4�........._. .�?��aL ....... N �
Facility Contact:
A04-r/Title: Phone No:
i.. �_..-- - - - _.. ...._.__ . .. -
Onsite Representative:�x.0_��r ..._. l� fi,[�.(� _ _ ... ... Integrator.
Certi>iledOperator:.._ Operator Certification Number: --- /_J,Ty;?.....
Location of Farm:
twine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 6 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 5;No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ETI o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes E3No
c. If discharge is Observed, what is the estimated flow in gal/min? �%
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes B -No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes a'f
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q-IQo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B'Iqtr-
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -------- ----------- ------------ --..._._._...-•---------._...
Freeboard (inches):
12112103 Continued

Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes BV -0-
❑ Yes Q No
❑ Yes ['No
❑ Yes [a'No
❑ Yes 21Qo
❑ Yes ef4o
❑ Yes [RNo
12. Crop type tae/ M 11ald I S`na / fru; a - 6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑'<o-
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes QW0
❑ Yes [}M
❑ Yes g ifo
❑ Yes 2180
❑ Yes DN(5-
❑ Yes ❑ No
❑ Yes 0 -go
❑ Yes D'1Go
❑ Yes ONo
:Comments {r�'er,tn question �) �Explaia any YES answers arnd/or any>reeammendattons or ar�y�o#her �minuen�._�Yy'� =;
F.Use dwu� oifa to Tbetter xplam sttnafrons. {its addtt�oaal pages as tiecessary) , ` D�eld Co Final Notes � s
T
Reviewer/Inspector Name 15-1
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: a �s Date of Inspection p
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/>V1TP_, cb-cck fists, da&ign,ziaps etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Wasm-Agpheati" [)FweebD7Tr ❑ Wasuo—A s ❑sampling
G L -.?l �`4'V-,ori 14 l`/
24. Is facility not in compliance with any applica�e setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes P -Ko
❑ Yes O -No
❑ Yes Q -Ko'
❑ Yes Oho
❑ Yes O1Io
❑ Yes to
❑ Yes B<o
❑ Yes ©-K
❑ Yes [l] No
❑ Yes [ fo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
ddiiianal C---"ents aiid/o`r Drawings - _ = c
lel—.--�...-.,.....
f
/ )
Re,.,-eW"el �� btl'sl' ,$ary/e 44^'.1C/OW. Sa»r��5 el -reg ood e 0 Woiyf 6el'oie s?./
G �7 fr .S u.. yelt dd{P,
12112103

Site Requires Immediate Attention:
Facility No. 8' Z - z s!
DIVISION OF ENVIRONMENTAL MANAGEMENT,
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S - z 1995
Time: ' 3 11•'311
Farm Name/Owner: _T5'0S6-"-,P r Ql v& OL V Z 9D 7
Mailing Address:
County: i►fPspna N
Integrator: d&,&94z Phone: 9/O —
On Site Representative: // Phone: — .�r9- 7Z
Physical Address/Location: 1>_!51 ( r xAe, o
f.oWdX 1,0 itgi . AJCr ,. ¢!!
Type of Operation: Swine Poultry 'Cattle
Design Capacity: Oa Q0 Number of Animals on Site: �'assd
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No
Was any seepage observed from the 1nes
n(s)?
Is adequate land available for spray?or No
Crop(s) being utilized: D .4 4 e -w.
Actual Freeboard: Ft. Inches
Yes or� Was any erosion observed? Yes or�
Is the cover crop adequate? es r No
Does the facility meet SCS minimum setback criteria?
200 Feet from Dwellings? (! s)or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(goj
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o !moo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acres a with cover crop)? Yes " o
Additional Comments: rr�•v enzP,� � �'a
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.