820261_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

1kf q Intra X A(
Type of Visit: Q Com nce Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 16 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time Departure Time County: -� Region
Farm Name: %� iii Owner Email:
Owner Name: MPhone:
Mailing Address:
Physical Address:
Facility Contact: j> L S Phone:
Onsite Representative: Integrator: Q �)
Certified Operator: [{� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream impacts
I. Is any discharge observed from any part of the operation?
[:]Yes
qo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑No
[3 -KA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
Ej 14A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[2o
[:]NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
ElYes
rlE]
NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

f
Facili Number: - Date of Incction: V
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes En.e�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes EJ- o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E>a— ❑ 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 U "o
❑ NA
❑ NE
waste management or closure plan?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E�'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ej -
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ,
CO -No ❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes I-1 o
❑ NA
❑ NE
maintenance or improvement?
the appropriate box.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes e -N -o-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q'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 D Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):���� 7 ��
13. Soil Type(s): �� ?
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (:.Ah' ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
aKo'__ ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3,Al D NA
❑ NE
Required Records &_Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CO -No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[rf'1 Imo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Desibm ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E2'K-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes EI�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes Q ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: Date of lns ection:
E]4o
❑ NA
❑ NE
24.•Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ g Nv— ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑-Ko_ ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus Ioss assessments (PLAT) certification?
❑ Yes
[].Ntf ❑ 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 o (DNA ❑ NE
❑ Yes [] <o ❑ NA ❑ NE
❑ Yes fo ❑ NA ❑ NE
❑ Yes t oo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
E]4o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
[ErNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[�o
❑ NA
❑ NE
Coniments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use. dravvings.of facility 6';better explain situations (use additional pages as necessary).
el
-7 f? 6 � 1;t-,
e + q
I
Reviewer/Inspector N
Reviewer/Inspector Signature:
Page 3 of 3
r
r '7
t p
3.06�6
�,v
'K.A('
1

J� ii79i5n of Water Quality S �-'s ! 3
Facility Number ®- Division of Soil and Water Conservation
� Other Agency
Type of Visit: UCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 04o-utine 0 Complaint Q Follow-up Q Referral 0 Emergency Q Other 0 Denied Access
Date of Visit:/7-/Q'' Arrival Time: Departure Time: County:
Farm Name: V"-"ek Owner Email:
Owner Name: �77 ell <7'"r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: t.�,l �jp�� : Phone:
Onsite Representative:
Certified Operator:, ,may Q
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Ponitry
Layer
Design
Capacity
Current
Pop.
., Design Current
Cattle Capacity Pop.
Dai Cow
❑ No
❑ NA
Wean to Feeder OD �JO
[:]Yes
]Non
-Layer
❑ NE
Dai Calf
Feeder to Finish
D , P1oultr,
Design
Ca aci
-= _`
Current
Po .,
Dai Heifer
Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
_
Ocher
Ml Other
Pullets
Turkeys
Turkey Poults
L10ther
L Beef Brood Cow
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes @ No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑No
❑ NA
❑ NE
❑ Yes
®. No
❑ NA
❑ NE
[:]Yes
C�g-No
❑ NA
❑ NE
Page l of 3 2/4/2011 Continued

Facili Number: - Date of inspection: --J 7'-'/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes?�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
❑ Yes
Designed Freeboard (in):
❑ NA
Observed Freeboard (in):
18. is there a lack of properly operating waste application equipment?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [,No ❑ NA
❑ NE
(i.e., Iarge trees, severe erosion, seepage, etc.)
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [&No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
9. Does any part of the waste management system other than the waste structures require [—]Yes ® No ❑ NA
❑ NE
maintenance or improvement?
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes Callo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E]`Application Outside ofApproved Area
12. Crop Type(s): _a'e /",-, ,-,, f ew" /U-/f/+'a 1S h�.�..�s %Lr�'Z r /�/7t ►u�'
13. Soil Type(s): f A
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 [0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
©. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
OFNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
El 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 [21 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [&No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: - Date of Inspection: —1 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2 No
E
` 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes D�_No ❑ NA ❑ NE
❑ Yes C&No ❑ NA ❑ NE
❑ Yes
[51 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:j —" e:D
Date: ~ Z% , 20/ 3
2/4/2011

type of Visit: tuoComptiance Inspection V operation xevtew U structure Evatuanon U i ethnical Assistance
Reason for Visit: OAoutine 0 Complaint O Follow-up Q Referral 0 Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: k_%L 7 County: gZgmD
Farm Name: 11 tV mv'ol FP q rv\ 3 Owner Email:
Owner Name: fkSlLy\ (IAn in h a t( _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu�� ���CZw Title: Phone:
Onsite Representative: Q(aNtt\ 6
Certified Operator: t�1-�h
Back-up Operator:
Location of Farm:
Integrator:
Region: V PD
Certification Number: !Ncivq
Certification Number:
Latitude: Longitude:
Design C•urrenf .
-•, ..
Design
Current.
esign Current
D19R
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cate Capaci -i Pop.
AM
Wean to Finish
La er
Dairy Cow
Wean to Feeder tpl�0 alal0
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P,_oultry
Ca aci
Po ,
Non -Dairy
Farrow to Finish
layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of 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?
0 Yes ESJ<o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes (El No
❑ Yes C!fNo
Q'NA ❑ NE
[!KNA [] NE
[fNA
❑ NE
❑ NA
❑ NE
❑ NA
[] NE
Page 1 of 3 2/4/2011 Continued

Facili Number:ala Date of Inspection: 'l
❑ Yes
E:INo
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;YNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[aoNA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
[—]No
NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Ila -1
17. Does the facility lack adequate acreage for land application?
❑ Yes
G3<No
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in): L
❑ NA
❑ NE
Re aired Records & Documents
Observed Freeboard (in): �$
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[22No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
['No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
[] NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ea No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
gNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eg"No
❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[::]Yes
Callo
❑ 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
E:INo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;YNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Qa No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
G3<No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E'No
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
['No
❑ NA
❑ NE
the appropriate box_
[DWUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[2(NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facilit� umber: - Q Date of Insp ection: t4'a.
❑ Yes
E2"&o
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
B34No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[RNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
l[ o
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
25_ Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
g3"No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'?
❑ Yes
[' No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
E2"&o
❑ 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
l[ o
❑ 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
[9KNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q Iko
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[j] o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]�/No
❑ NA
❑ NE
Comments (refer to question #) Explid 1,a y YES answers�and/or any addittona[;recomniendations or any other comatents.
Me d awinngs of facility to beifer expl ins ations;(nse additional pages; as necessary.).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
D5
Phone: 1�SS5�
Date:
2/4/2011

t ype of visit: (® Compliance Inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:� Arrival Time: /.',�p� Departure Time: County ��q p�,rfy Region: 02
Farm Name: � I p t{Lb6 li',AMlol a Owner Email:"`—
Owner Name: �, �D� Phone: y
Mailing Address: R.(1 , j�_ _ (�, �� �i�}b{Z yoe
Physical Address:
Facility Contact: Title: Phone: -07 30o
Onsite Representative: Integrator: A A i*V GIQGteAl
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: G82q
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)
❑ Yes M No [DNA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
M NA ❑ NE
fM NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No IM NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ( No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued
Design Current
Design_
,Current
Design Cttrrent
Swine
Capacity Pop.
Wet Poultry
Laity
Pop.
Cattle Capacity Pqp.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I iNon-Layer___[___Dairy
Calf
Feeder to Finish
a.9 yp G ?
Dairy Heifer
Farrow to Wean
De` sign
Current
Dry Cow
Farrow to Feeder
D. P,oul
Ca`aci
1'0 .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Co—
owTurke
Turkeys
s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes M No [DNA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
M NA ❑ NE
fM NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No IM NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ( No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

Facili Number: a -al jDate of Inspection: 107
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _t(O
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes E ] 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
rM No
[DNA
[:]NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z 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): Q�ZiLMIL2" . 1 !-i� 1. -!�k. c. cel 1 PLiksF.cT"� 'A R lr7o0j*
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes No ❑ NA ❑ NE
VU
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (A No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes No
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IM No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[$] No .❑ NA ❑ NE
�]No ❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

FaCill Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�] No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
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 Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[] No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
E] Yes C@No E] NA E] NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes of No ❑ NA ❑ NE
[:]Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
[DNA F] NE
Commentss(referitolquestion ft Explain any YE&answers and/or any additional recommendations or any otber�,com'e"n'ts.
Use drawings of facility to better explain situations1iise: additional vaees as necessarVi
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
Phone: q10' 4 33 '333a
Date: ldr�a 11i�0 l l
Tim
2/4/2011

type of visit: Vitiomptiance Inspection V Vperation Review V btructure Evaluation V -Iechnicat Assistance
Reason for Visit: 04outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Q, Departure Time: ' County:Region: ici�ej
Farm Name: 3 Owner Email: '�`��
Owner Name: �l I� Phone:
Mailing Address:
Physical Address:
Facility Contact: S y ii - Title: 1 �!C_ Phone:
Onsite Representative: XkyQ Integrator: M B
Certified Operator:tjyl tm Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2-&—o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design C►urrent
W— rig;current
�'
Design Current
a. Was the conveyance man-made?
Swine
1pacity Pop.*�Wet¢Poultry
.
amp.. Pop.
Cattle Capacity Pop.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
lid" A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Finish
Wean to Feeder
Feeder to Finish
,tea
La er
Non -La er
, -
Pairy Cow
Miry Calf
Dai Heifer
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
Farrow to Wean
❑ NE
Design @urrent
D Cow
Q -No
Farrow to Feeder
❑ NE
D 4 �l'oul � apiki
` 'Ca act P,o
Non -Dairy
Bio
Farrow to Finish
❑ NE
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Co-
owTurke
Turkeys
s
Other
Turkey Pouhs
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2-&—o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
J3<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
lid" A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
[�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Bio
[] NA
❑ NE
of the State other than from a discharge?
Page I of 2/4/2011 Continued

FacifitViNumber: jDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B<o ❑ NA ❑ NE
a. If yes, is waste Ievel into the structural freeboard? []Yes ❑ No fiQ-<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
BNo
Spillway?:
❑ NE
the appropriate box.
Designed Freeboard (in): —
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U 'moo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
p Weather Code
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ka<o ❑ NA
❑ NE
waste management or closure plan?
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
g3r<o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[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
[/'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L?1 o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window EvidenceJof Wind Drift ❑] Application
of Approved Area
12. Crop Type(s): � � 14, l l_c,, .
�Outside
(t31A�L�� �
� ,, iL,
13. Soil Type(s):I
_t.}�'1 tom .} S - —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3 <o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [R'�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q'F o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [1]'10 ❑ NA ❑ NE
❑ Yes �fo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
BNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EKo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
p 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
CD4o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[] No
EKA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facility -Number: - jDate of Inspection:
7-1
14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U�r<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes B<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E3<qo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
t E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[+r No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
3No
❑ 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
[v] 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
[g' 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
Uo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
&No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2'�o
❑ NA
❑ NE
Cornments-(refer-,to
question ft Explain any YES answers andlor any additional recommendationsorianyothersomuieiie draW►ngs,Df.facility to. better explain situations (use additional pages as necessary): _ 1,`.�m g
y
`tom j pLAj'-f 5s 4ke_ C,_ tr-o . vb
c,,,� C 4,, W° AL- we
U
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone: `f!O ^ 31..33�
Date:
2/41201

Division of Water Quality
Facility Number-� 0 Division of Soil an ILW.ater Conservation
Q O#her AgencyP M �7i
Type of Visit Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assis=Access
Reason for Visit *Routine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denie
Date of Visit:Z Arrival Time:� r
Departure Time: 'a�i� 1+�+ County: - A'PhQSB� Region: •-
9
Farm Name: ►4^'5 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact:Ln Title: Phone No:
Onsite Representative:
T L integrator: &Vk-0y_Un,
Certified Operator:y CA 4 Operator Certification Number: 221 �Q� _
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [::] 0 0 ' [_—] sLongitude: ='=' = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PgNo ❑ NA ❑ NE
❑ Yes
Design Current
P NA
Design Current: Design C•nrrent
Swine
Capacity Pop latio..n
Wet Poultry
Capacity Populaholi Cattle Capacity Population
❑ Wean to Finish
❑ La er
[�NA
❑ NE
❑ Dairy Cow
❑ Dairy Calf
❑ No
Wean to Feeder I 121M
Non -La er
Feeder to Finish
❑ NE
❑ Yes
El Dairy Heifer
❑ Farrow to Wean
❑ NE
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑.Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood-Co—
roodCoTurke
Turkeys
s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures
�,�..-#ori•°
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PgNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
[RNA
EINE
[�NA
❑ NE
❑ Yes
❑ No
❑ Yes
Pq No
❑ NA
❑ NE
❑ Yes
q No
[:INA
❑ NE
Page I of 3 12/28/04 Continued

- Facility Number:
Date of Inspection l r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):N
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 9 No ❑ NA ❑ NE
❑Yes El No ;9 NA El NE
Structure 5 Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes R 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] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes '�"W'No ❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 29 No
❑ 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 Soi:
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
❑ NA ❑ NE
13. Soil type(s) p L C — Jo r
t4. 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 51 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #):�xplainYES answers an Vb-r ny recommendations or any other commenUse drawings of facility to betteons. (use additional pages as necessary):
Reviewer/Inspector Name u _ j J Phone: '0-13 .700
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 ' Continued

Facility Number:— Date of Inspection f0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ V*rUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
;9 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
TNo
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
fjjNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
1p 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
JFNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[4 No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit 4p 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: L Iv l{T Arrival Time: OQpti Departure Time: i a 1 t Oa County: ��� Region:
Farm Name: 10
Owner Email:
Owner Name:—t7Il1t u�?,�jez� Phone:
Mailing Address:
Physical Address:
Facility Contact: _�t7 it eo rt C Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
gql 7aY
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =D =I=,, Longitude: = ° = I = "
Discharges & Stream Impacts
Design Current Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ DaiEy Calf
PQWean to Feeder p ❑ Non -La er
Feeder to Finish
_ _
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
No
E]Non-Dairy
El Farrow to Finish
❑ La urs
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boats
❑ Pullets
ues
❑ Beef Brood Co
❑ NA
urku s❑
❑ Turkeys—
2. Is there evidence of a past discharge from any part of the operation'?
❑ Other
ElTurkey Poults
❑ Other
Number of Structures:
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
No
ll
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
EINE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[V No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ies No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: `
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes (y 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?
V] Yes
❑ No
[:INA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ YesNo
Ep
❑ 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
rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[? No
❑ NA
❑ NE
maintenance/improvement'?
]I.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P 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 [:1 Application Outside of Area
12.
�❑1
Crop type(s) G4 Ta L rW�O�. 4a;X CS 61a.7P�+ , t t� t�L p��
w 'ir'47
13.
Soil type(s) rT�y
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes]
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
4 No
❑ NA
❑ NE
Laments (refer.to question #) .Explain aiiy YES answerskand/or any recomttiendationsar any other comments.
Use drawings of facility to'.better explain situations (use adffitional pages as necessary)
7 � ('44— o VX ati.ea
,t-ee h g ou g aK, asooh .
Reviewerfinspector Name Phone: /D `f3 3 r330o
Reviewer/Inspector Signature: Date: D 'Z! p`3
12128104 Conhnued

Facility Number:cz�-_ 1264Date of Inspection EZOU
Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
R jNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
OFNo
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�1No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ,B No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E9No
❑ 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
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
Additioual�Gomments aad/or;Drawrngs � �;,,,,,
��w �.
1.��`"t _ w r rr 6 Sl! 4 Go f,
a
12/28/04

Type of visit 4P Compliance Inspection Q Operation Review Q Structure Evaluation Q 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: 1 r "00 &A I County: _SA"%P-<C^) Region:
Farm Name: �PXI n►rt A3 Owner Email:
Owner Name: AJ 6 Canf?QdL Phone:
Mailing Address:
Physical Address:
Facility Contact: {>'► Title: Phone No:
Onsite Representative: t� Integrator: Ur
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=& =61 Longitude: =0='
°=' =
As
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
tO'No
Design Current" Design Current
Swine
Capacitypulatiin
Wet Poultry
_.
'm —PA CattleCapacity Population
❑ Wean to Finish
`
❑ Layer
❑ Dairy Cow
Wean to Feeder
aG00
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ No
1�§NA
-- ❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
= ❑ Dry Cow
❑ Farrow to Feeder"
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
t"� El Non -Dairy
❑ Farrow to Finish
❑ NE
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ NA
❑ Non -Layers
Beef Feeder
❑ Boars
f§No
El Pullets
❑ Beef Brood Co
other than from a discharge?
�,.
❑ Turkeys
Other
❑ Other,
Page I of 3
❑ Turkey Poults
❑ Other
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
tO'No
❑ NA
EINE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
IP NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1�§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
DNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
f§No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28104
Continued

Facility Number: 'gd`Ar,Z o
Waste Collection & Treatment
Date of Inspection I r t
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No UNA ❑ 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 'VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [P 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 N ❑ 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 YbNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
4)111 6t 01-0 0KCQ '"' r S iLed 6"'1-
maintenance/improvement?
yyCXt/1r,
J
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application of Area
12.
�Outside
Crop type(s) Cv►n mss S Swt,4—©wr�ot
13_
Soil types)m— -IA5
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
UqNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
FJ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
.�qq
a.d No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
9No
❑ NA ❑ NE
Gomrnents (refer to question #): Explain any YES answers and .or any recommendations or any other comments.
Use drawings of faciliuse additional pages as n�essary,):
A6
4)111 6t 01-0 0KCQ '"' r S iLed 6"'1-
yyCXt/1r,
J
Reviewer/Inspector Name '� Phone: 210-x(33 `33CD
ReviewerlInspector Signature: Date: IOLZSLts
Page 2 of 3 12128104 Continued

Facility Number: a— Date of Inspection 1�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi Maps Design ❑ Mp El Other'
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
r No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[#No
❑ NA
❑ NE
❑ Yes
JpNo
❑ NA
EINE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
1 No
1
❑ NA
❑ NE
❑ Yes
NQ No
ElNA
ElNE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
QDNo
❑ NA
[:INE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
( No
❑ NA
EINE
Addifionm
al'Coment`stadlor Drawing'
. \
_
srujjt (&—ovoij
P /a;i
C0...e� -/
i
Page 3 of 3 12128/04

0 Division of Water Quality
Facility Number �. o'�(o O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance inspection O Operation Review O Structure Evaluation (:) Technical Assistance
Reason for Visit a Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: W. i Arrival Time: M Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: u Integrator:�T_
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region: A&
Latitude: [=]' =' ❑ « Longitude: =0=1 a "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
3 ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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)
DesignCurrer
Cattle Capacity Populat
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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
Wo
[:INA
❑ NE
❑ Yes
❑ No
_RNA
❑ NE
[:]Yes
❑ No
_UNA
[:INE
C.NA
❑ NE
❑ Yes
❑ No
❑ Yes K] No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
12/28/04 Continued
J

Facility Number: rL— a ( Date of Inspection ! 13
7� wvrlj�5 oK ire cis aroLA q coo.
Waste Collection & Treatment
14. Do the receiving crops differ from those designated in the CAWMP?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
OYNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No JnNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
IF No
❑ NA
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in):
❑ Yes
EpNo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M)No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ANo ❑ 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?
RYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ep No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EP 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 indow ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) ox-Ljjq Sw.,o Vt O
13. Soil type(s) Piz 6 —
7� wvrlj�5 oK ire cis aroLA q coo.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
IF No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EpNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7� wvrlj�5 oK ire cis aroLA q coo.
Reviewerllnspector Name Phone: 0
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 91 No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes nNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 'M No
[__1 NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
- 28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[)INo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 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
FPNo
❑ 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
V No
❑ NA
❑ NE
General Pen -nit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[p No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[P No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

♦r__
cL 1'7 /4-!Z 1 7//4- 17 00 (1
Type of Visit 40 Compliance Inspection ()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: Departure Time: County: a Region:1� b
Farm Name: A l l a m 0—ting pT FAA mAl 3 Owner Email:
Owner Name: A Aft otpT Phone:
Mailing Address:
Physical Address:
Facility Contact: A I (ARCAtt_n R Domf Title: 6 f_f A,P R Phone No:
Onsite Representative: Allan CA rt A D ,,-1 1 ntegrator:
Certified Operator: -- g_PCc in M r,1% Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ I = Longitude: = ° =,
❑ u
. ..�
Swine
Wean to Finish
Design Current
Capacity population
a� Demos g 4 Current
,, &.
W�etaPoultryVCapacitykPopulation
❑ La er
Cattle
❑ Dairy Cow
Design Current
C*apacity Population
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Wean to Feeder
Layer
❑ Dairy Calf
❑ Yes
❑ Feeder to Finish-
El
❑ NA
��, _
Dai Heifer
❑ Yes
Farrow to Wean"4�k
❑ NA
Drys Poult
❑ Dry Cow
El Farrow to Feeder
_°�,.;�. ,n�... M^�v'�,�,',.rs��,
❑ Non
❑ Yes
❑ Farrow to Finish
❑ NA
❑ La ers
-Dairy
❑ Beef Stocker
❑ Yes
❑ Gilts
❑ NA
❑ Non -Layers
❑Beef Feeder
❑ Yes
❑ Boars
❑ NA
❑ Pullets
❑ Beef Brood Cow
:.❑
Turkeys
Page 1 of 3
Other�w
a;
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
§6 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NJ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
00 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

'j 3-t a
Facility Number: a — (a Date of Inspection '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a L411 _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(�f No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require es
WY
No
ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
11'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
$ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
in No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
V] No
❑ NA
❑ NE
Comments (refer to question ##): Explaut.any YES answers and/or any recommendatio. ns or any other comments F ':
Use drawings.of facility to better explam`situations. (use additional pages as necessary):
#R' V k0.tv1 tvv�J0�,0.sr ��� � IEZ05 'ko b �� E -V Alua�A`GrAS'�-F
Reviewer/InSpector Name I <
Reviewer/inspector Signature:
{ Phone:
Date:
Page 2 oj3 12/28/04 Continued

%acility Number: as `oZV Date of Inspection __T
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Vs o ❑ NA [:] NE
❑ Waste Application ❑ W Freeboard ❑ Waste Analysis [j Soil Analysis E] Waste Transfers RrWeatherCode
al Certification
❑ Rainfall ❑ Stocking rop Yield El 120 Minute Inspections El Monthly and V Rain Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
❑ Yes
0 No❑
NA WWi�
IV -Yes
[pj NA
[INE
Yes
o
❑ NA
El
❑ Yes
El No
iv
❑ NE
❑ Yes
Ul No
❑ NA
❑ NE
❑Yes
MNo
El NA
El NE
❑ Yes
[V No
❑ NA
❑ NE
❑ Yes [VNo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes )] No ❑ NA ❑ NE
Additional Comments and/or Drawings: x k
lyo [�LCot�D oX Chat -r_ Faz0 R
_
Page 3 of 3 12/28/04

m
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -J y Arrival Time: , > Departure Time: County: �tF_r►+Af�,�_ Region:
Farm Name:%1&4 ��nr) u��y �n{m3 Owner Email:
T
Owner Name: - 14g1:`, Phone:
Mailing Address: _ Ci r,'r �atfcC ..._ 44 4/e, /VG �323? _-
Physical Address:
Facility Contact: l e � ' i Title:
Onsite Representative: Alle1 tt�
Certified Operator: �rl z4r u
Back-up Operator:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=d
❑ Longitude: E] o ❑ ' = W
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I 1—❑ Layer
04can to Feeder p ) u v 10 Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other I i ::::::]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cukrenti;.=
Cattle Capacity Popuigtiiin;..:
❑ DaiEy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod _
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?
0
[_1 Yes UNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®-No
❑ NA
❑ NE
❑ Yes
❑,<o
❑ NA
❑ NE
12/28/04 Continued

Facility Number:—„ 2(� Date of Inspection 0
❑ Yes
ZNo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
❑ No
❑ NA
ONE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: /_
Spillway?. n o
Designed Freeboard (in): '241
Observed Freeboard (in): -lit. 5-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
gff o
[INA
❑ 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
0"No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes BNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes Q'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
1 so ;L 0 /_ v �5 i_0
12. Crop type(s) 1�f r r .rJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
❑'No
❑ NA
11 -NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
SNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-<o
❑ NA
❑ NE
1 , Aver[, /v lol&ee et C: _ e.r/ C 14.5 oci­ I
Reviewer/inspector Name Phone: 6:1 73[
Reviewer/Inspector Signature: �, Date: 117 U5
12/28/04 Continued

Facility Number:, — )G Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 -fes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ElYes 044o ❑ NA [INE
the appropirate box. ❑ WX El Che sts [:3D5096"'13 M�❑ Oth�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ pp7�jca//t eekly Freeboard 1s 1:1Soil A�tatysis ElWast ran f M El�ainfall Egg tucking ❑ Crop Yield ❑ 120 Minute Inspections EI-ltTionthly and 1" Rain Inspections ❑ W-eat#eF E�
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
01(es
❑ No
❑ NA
❑ NE
❑Yes
[:1 No
El NA
❑ Yes
❑ No
❑ NA
0'1GE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
D -leo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
9'<E
❑ Yes ,I��J NO ❑ NA El NE
ElLd
Yes "No ❑ NA ❑ NE
❑ Yes L1 No ❑ NA ❑ NE
❑ Yes 0-<o ❑ NA ❑ NE
❑ Yes ED<o ❑ NA ❑ NE
❑ Yes EINo ❑ NA ❑ NE
Additional • :��' h�' -x
Cozaments'andlorDrawmgst ,
1�I r'C: y f° (.��i 4`' L� r7
Cl�J�'I�G" ✓ r�I �G'•'r'-I � ° : �`-'� cz; C�
WP�F /7
Z
f�/y
G n�� i /` u ,�7 --r- 3P���.G"7 r
[(f c•
A-,,
% I
i'e �� c�; -��/ f
ice, r
�� / 'iTi
W a
i J 1
mCar %i [i:Fy Gf 6'G 04'�j� C✓�� G7i GT ii7 (] /-�+
\
���i.� �': ten.
C'f �ti� nr�. Fps.-,•,,r�
�,�4% ��,�>l
�j�,�n.'c7v" G✓. �' '{ r I � L'„s"
Lr� %%•1 � ..'� 1C:��r' (�L. �r V,l
��
Jr,c.. 'c'CC'.':f ", 1!
i
12/28/04

�v
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilitt Number ,2 Datc of Visit: Time:
L-• -
=Not erational 0 Below Threshold
13Permitted 0 Certified_ 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 17 t e 111.14it ren County: S QAC r
Owner Name: 4'i1 / Phone No: —rll.9 "-5 9r
fln --
ailing Address: — �1 ! Gf zi e �
_" T -- — l rn �
':2 A.,
Facility Contact: Title:
Onsite Representative:
Certified Operator: A.An C4 qv
Location of Farm:
Phone No:
Integrator- /c4J
Operator Certification number:
®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` 0 " Longitude ' 0•
Design Current
Swine Cnnar:ty Pnnniafinn
RJ Wean to Feeder 400
❑ Feeder to Finish
❑ Farrow to IV=
❑ Farrow- to Feeder-
Farrow
eederFarrow• to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Pouhw• Ca acity Po ulation Cattle CaiDacitv Po elation
❑ Laver I I❑ Dairy
❑ Non -Laver I I ❑ Non -Dain
❑ Otber
Total Design Capacity
Total SSLW
Subsurface Drains Present IILI Lagoon Area
Discharges d Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is obsen•ed. did it reach Water of the State? (If yes. notifi, D WQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pati of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
t
Freeboard (inches): 0
05103101
Continued
❑ Yes
No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
Dd No
❑ Yes
® No
❑ Yes
® No
Structure 6
Continued

Facility Number: „? —,Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes � No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes (M No
(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? ❑ Yes W No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes QZ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Applicatian
10. Are there any buffers that need maintenance/improvement? ❑ Yes EM No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes IM No
12. Crop type QA, r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [0 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes UZI No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
JKYcs
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Pian readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
;9 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sampic reports)
❑ Yes
ERNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes Q No
24. Does facility require a follow-up visit by same agency? ❑ Yes W No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes LKNo
10 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
COC- was Ad CA 5, �e r Keccmmexa(ahi ,,i
a r [owra. le o�1 -(-,-Ie of a //
Reviewer/Inspector Name (-
Reviewer/Inspector Signature:
❑ Field Copy ❑ Final Notes
o -"f /r we To eAfdle coil' oe-4 e
Me -s,
Date: (-07/-0
05103107 1Continued

❑ DSWC Animal Feedlot Operation Review
0 DWQ Animal Feedlot Operation Site Inspection
10 Routine 0 Complaint 0 Follow-up of MVQ inspection 0 Follow-up of DSWC review 0 Other
Date of In_4pection
Facility Number
Time of Inspection /7' 24 hr. (hh:mm)
0 Registered 0 Certified //©3 _Applied for
Permit 0 Permitted 10.Not O erational `Date Last Operated: ...........................
Farm Name: �.Ei✓..0 "�iRD' ......... County:...........! !Q �OwJ......................................
�_ . - .. .. ............... --.. ---. p /
Owner Name: .�.J..g.�!!✓! .. Phone No: C1�,..1.......b.../.........
Facility Contact ...moi - �. Title: ................................................................ Phone No: ............................ I......................
................................
Mailing Address: .....
I7mid...,t!r✓itw.�X.r......,.....lif.M{-....>t..t.L.R.....................
Onsite Representative: ........... -s. ?'.:............................................................ ...... lntegratur...... f" '`�.. ..................
Certified Operator, .......�!/{✓........................ -�✓�/�O Operator Certification Nnmbrr,.-..-...-.....-..
�................ ........................
Location of Farm:
................................................... ....... ......c ...... .............. .... .......... .... ............
[';4 , ----- 7
f..,.S.---.��1�-fry.-._..... ,�. ............... . ..............� .:.. .
Latitude Longitude
Design Current Design • .- Current
Swine Capacity'. Population
Wean to Feeder Ldp
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity: Population
❑ Layer
❑ Non -Layer
Design . Current
Cattle Capacity, Population
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons./ Holding Ponds JEI Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes J4 No
2. Is any discharge observed from arty part of the operation? ❑ Yes USNo
Dischar2c oriainat d at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes 15d No
b. If discharge is observed, diel it reach Surface Water? (If yes. nutifv DWQ) ❑ Yes RNo
c. If discharge is observed, what is the estimated flog' in gal/min?
d. Does discharge bypass a lagoon syste3ot'? {If yes. nntify DWQ) ❑Yes No
3. is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Sj No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 99 No
mai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes f9 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P No
7/25/97 Continued on back

r
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes )K No
Structures (Laaoons.11olding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IR No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
12.
Freeboard(ft): ......... .. S......................................................................................................................................................................................
10. Is seepage observed from any of the structures'?
❑ Yes
JQ No
H. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
� No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
Reviewer/Inspector Name
Reviewer/Inspector Signature:_ Date: l�'`
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Rd No
Waste Application
14. Is there physical evidence of over application'?
❑ Yes
R No
P``or runoff entering waters of the State, notify DWQ)
(If in excess of WM//.....
15. Crop type ✓............. lx- ...
............ .... ........... � ..................................................:..........................................•-. ..........
........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
OkYes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
OkNo
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
q No
20. Does facility require a follow-up visit by same agency?
❑ Yes
A No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
KNo
22. Does record keeping need improvement'?
❑ Yes
K No
For Certified or Permilled Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ANO
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
A�No
25- Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
INo
Q No violations or deficiencies. w' ere noted -during' this "visit. .Yoiu.will receive no further
correspondence about this'visit.
CGihn:i nts (kfer to question #): Explain any;YEb absKers and/or any recommmendattons or any tither comments '
sus -k' < . ^ k ., - ¢s.s➢...�C .:'' a xm V, 5R
Us6*awtngs of facthty to better explatni situations '(use additional pages as:necessary) >
F ri� u. M k•a
/%7.C. �Ay✓ �.�/F i! ��.0'' Y4Ifs r�ofJJ(crC l�+i�sQ+� O^�//Jr� E.SGO�%�
12.
7125/97
T
Reviewer/Inspector Name
Reviewer/Inspector Signature:_ Date: l�'`