820330_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

4j
h16-- 3-! �L- /.s-
jType of Visit: 1E'Ciance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — - ,D Arrival Time: O , O Departure Time: r} County: Region:
/� L7
Farm Name: V Gs- 111 � i JZ I Gl. e'Pw-- Owner Email:
Owner Name: r ` �,e Phone:
0A
Mailing Address:
Physical Address:
Facility Contact: Ch el7 i 'g Yy Title: ,Q44..�,n Phone:
Onsite Representative:, -_ Integrator: Z
Certified Operator: �5�..4�� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pnp.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
.
Dt. Poul .
Design
.Ca aci
.Ca aci
Current
P,o ..
Fop..
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non-DaiEX
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
ITurkeyPoults
Other Othcr
Discharges -and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [&No [] NA ❑ NE
❑ Yes ❑ No
[:]Yes [—]No
Yes ❑ No
❑ Yes C,No
❑ Yes C21-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
Page 1 of 3
21412014 Continued

Facility Number: Date of Inspection: yn —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4. Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes No ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[RNo
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cg 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): _;reou-*
13. Soil Type(s): p rjeV`A r Z ,z=ae_ �e /; Ile
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [[No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Callo [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes LD No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EZ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: a - Date of Inspection: A 3— 10 —
r; 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®. No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 ❑ Yes ® No
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
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 IS No
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 M No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �( No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ZNo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes J! No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comnccnts'(refec to questionN): Explain any'YES' answers and/or�any'additional recommendations or any other comments.
Use drawings of:facillty:.to befter'expiain:situations (use:additional _ ages as necessary).`
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:L��3 33ex7
Date: ®3 l0
21412011

F
1,
lL
i'vieion oT Water Resources
Facility Number ®- JJ'o Division of Soll and Water Conservatlon
Q Other Agency
Type of Visit: omplin a Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Z,9.100 I Departure Time: County: s r�
Farm Name: e3w i VL �'� Sl��/'Jr ,,mom Owner Email:
Owner Name: �j jai i ����—dam �Gt ri �� Phone:
Mailing Address:
Physical Address:
Facility Contact: 4:::z � Title: Phone:
Onsite Representative: �.
Certified Operator:
Back-up Operator:
Region: lc R D
Integrator: /'/ /--� /�k
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes & - No ❑ NA ❑ NE
❑ Yes ❑ No
[:)Yes ❑ No
❑ Yes [:]No
[:]Yes allo
❑ Yes 0 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facility Number: - 'D Date of Inspection: f
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3.No ❑ NA ❑ NE
is
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ _ —3l
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
JZ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
_(2
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 [3-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): �rMgtdL
13. Soil Type(s): ,L 2r7CV/k % 7'�aG4-_ Mf_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E�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?
Required Records & Documents
❑ Yes [a No ❑ NA ❑ NE
❑ Yes CE No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S_No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eallo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes IS —No ❑ NA ❑ NE
❑ Yes allo
❑ Yes [3No
❑ Yes JZ_No
❑ NA ❑ NE
[DNA ❑NE
(DNA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to. better explain situations (use 'addltionil pages as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: y'p'1S _';i214
21412014

17114I1�
• Division of Water Quality
Facility Number 330 0 Division of Soli and Water Conservation
O Other Agency
Type of Visit; 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: iD Routine O Complaint O Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: i J
���
IL, Arrival Time: Departure Time: County; SAnA eSa4J
Farm Name: .I R, _ _ Owner Email:
Owner Name: U, �}-� Phone:
Mailing Address:
Physical Address:
Region: f-44�0
Facility Contact:�Title: Phone:
Onsite Representative: H Integrator: /✓ir��o�t.�t-h
Certified Operator: Pi Certification Number: qU & 05g
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
L Z Non -Layer
Pullets
Other
Poults
Design Current
Discharaes and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Bcef Brood Cow
❑ Yes rWNo ❑ NA ❑ NE
Ir
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes A No
[:]Yes Ej] No
® NA ❑ NE
�NA ❑NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: SIT - 550 Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IQ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 'o NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[W No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
q9 No
❑ NA
❑ NE
0 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 ❑ idence of Wind Drift ❑ Outside of Approved Area
/Application
12. Crop Type(s): al L3-tFQ,jti V
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
T[
D NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 MNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes [�No ❑ NA ❑ NE
23. If selected, did the facility fail'to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: IDate 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 lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
fV No
[DNA ❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes © No
❑ Yes Ep No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes (5g No ❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 t 0 --(33 -3 3c:29
Date: i )Z
21412011

Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: I&Lei
I U Arrival Time: a� Departure Time:. ' I County:
t �
Farm Name: SW trr.e v%,% Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
CkIrt�S �t t
Title:
Onsite Representative:
tr
K
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator: --t,
Tr
Certification Number: /V > E7
Certification Number:
Longitude:
Design C+urrent Design Current
Swine Capacity Pap, Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
o-
t
Wean to Feeder
F eeder to Finish
a.2 Q
Ion -Layer a
"" ° `�
� � � � ��;
Deyi R Zii_rTCfltN
' Drr �,l'oultr �Ca aci Po �5`�
.,i _
Dairy Calf
DairyHeifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Other
Discharecs and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
❑ Yes V No ❑ NA ❑ NE
❑ Yes []No
[:]Yes [:]No
4 NA ❑ NE
1P 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 Rg NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes j 5 No ❑ NA ❑ NE
of the State other than from a discharge? TT
Page I of 3 21412011 Continued

1~acillt Number: - Date of Inspection: 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes I 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 1%} No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [] Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window ❑ Evidep5ge of Wind Drifter [:] Application Outsi of Approved Area
12. Crop Type(s):Q"L eC.1'. Ss L/T .Sh • �T�ti
13. Soil Type(s): V_ -
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination'?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
rM No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Cvo ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes � No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? 1f yes, check the appropriate box below. ❑ Yes b] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J�] No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

rF-acil Numher: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If, yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
T 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
Co 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
19 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
Tj
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
g] No
❑ NA
❑ NE
Comments (refer to question #):' Explain any YES answers`andlor any additianallecammendatlonsfor any°othcr�comrrtent5
Use drawings of facility to: better explain situations (use additional pap -es. as necessarv).:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: i
2 412011

i
Division of Water Quality
Facility Number U2� MD 0 Division of Soil and Water Conservation
0 Other Agency
j
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0,11outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: C 0 Arrival Time: dU; Departure Time: County: fS6 J Region: ZD
Farm Name: , nf,
Owner Email:
Cf ++ Owner Name: �S C7yy1� Phone:
Mailing Address:
Physical Address:
Facility Contact: If 1 Title:
N
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Gilts
4
Phone No:
Integrator: P 1t�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 O 0 1 Longitude: =°= i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
WiD I ❑ Non -La er
Other
❑ Other_ --
Dry Poultry
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 Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Pry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: T—J]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: —3 Date of Inspection t 0
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
5truclure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[1 No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
1
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
T No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[!&No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Ep-No
❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
§ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Area
//❑
12. Crop type(s) &011j, ASS,
13. Soil type(s) /No-/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
lNo
❑ NA
❑ NE
Does the receiving crop and/or land application site need improvement?
❑ Yes
�15.
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
q5 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Cp No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ep No
❑ NA
❑ NE
':�.:�:1}J vS'.F''�,�y`k �f4.
Comments (refer to question #). Explain any YES:�nswcrs and7o'r any recommendations or any other=commentsY, .,
,Ilse drawin `s offacilit to better ex Iain situations use additioial� a es asiieccssa r3'} F
t
7
n 7 ?+7'
Reviewer/Inspector Name ff
q P k "'� 4, i � � � w ,; " �fi , ^ w ' i �
�:y3_ w Phone: !o - Sop
Reviewer/Inspector Signature:7aw
Date: t
Page 2 of 3 12128104 Continued

Facility Number: $ 2—O Date of Inspection t t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EP No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes � No [I NA ❑ NE
the appropriate box. [IWUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M 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
CNN
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
TNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes]
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�j NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
R9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ 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
1p No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[P No
❑ NA
❑ NE
Additional Comments„anr. dlur Drawings "` �' °�� "i r`�a 3
Page 3 of 3 12128.104

ArNS 2-05--2010
lvision of Water Quality
Facility Number Z I 330 O Division of Soil and Water Conservation
0 Other Agency
Type of Visit t�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outlne 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: ; 3S Departure Time: ;O0 County: _54!t
Farm Name: I'Fusrel/ ateaz Owner Email:
Owner Name: Ca xx el RR Y'g'- Phone:
Mailing Address:
Region: TP`y
Physical Address: /� L
Facility Contact: l.4ee' s Title: Phone No:
OnsiteRepresentative: Cur-i�`_S �C3at��..u�k Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = f 0 " Longitude: = ° = ` = `d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
2 ❑ Non -Layer
❑_J
Wean to Finish
ER
wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other___
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & 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)
a
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
E3NA
❑ NE
❑ Yes
❑ No
3NA
❑ NE
❑ Yes
El No
[3NA
El NE
❑ Yes
a No
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 82— 3
3701 Date of Inspection r-ax —/o
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 to ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
R<o ❑ NA ❑ NE
(ie/ largetrees, severe erosion, seepage, etc.)
�
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
2 o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthreat notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
o ❑ NA ❑ NE
8. Do any of the stuetures lack adequate markers as required by the permit? [I Yes
�[vo ❑ NA El 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
L`JNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,�.��No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
l_J 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
L9 No ❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
4FF 4?�q I nxl ail�l.' p ". . r ^ -'. ` '.'.'' .: . �, �:
Comments (refer tW,question #) explain any YF.S;answers:an'dlok any Main 4 endajions or Any other coma cats �I y r
` p . (use additional pages as necessary):. ` � facility IA#n sltuatlOns Use drawtn s o
z
f facili to better ex
Reviewer/Inspector Name jG i` jL C >/r„�' Phone: q/d� y33 , 3joQ
Reviewer/Inspector Signature: Date: %-2Z
12128104 Continued

Facility Number: Date of Inspection
Required Records &_ Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CTONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists . ❑Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2<0_"11 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
]off [I NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El,�,,, Yes
L'�`No NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o� ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L�' o ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErNo ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
GT<o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EreNo ❑ NA
❑ NE
12128104

-9ZwtS /o-OS-ZovR
Q'15ivision of Water Quality g
FFClik N. i bC1 g 2 3 Q O Division of Soil and Water Conservation.
O Other Agency
Type of Visit
ompliance Inspection
0 Operation Review O Structure Evaluatlon
0 Technical Assistance
Reason for Visit
I-toutine O Complaint
Q Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: 9- / - 091 1 Arrival Time: �� t)P Departure Time: y.�3a County:
Farm Name: Russo_// Pa �l�t✓✓ � f ' ` `"� Owner Email:
Owner Name: Ru Ss c_LI Phone:
Mailing Address:
Physical Address:
Region: la?®
Facility Contact: l uk4'S Say i-if'— k— Title: ! tee. L . �4- r-c—Phone No:
Onsite Representative: r3o -&-?lc Integrator: t r� V
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: =° = 1 =
11
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
Wean to Finish
L_I Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ uhs
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Dumber of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑-K-6__ ❑ NA ❑ NE
❑ Yes
❑ No
[3-MA
❑ NE
❑ Yes
❑ No
E]r9A
❑ NE
0'1 f�A
❑ NE
❑ Yes
❑ No
❑ Yes
[31To
❑ NA
❑ NE
❑ Yes
9-ITo'
❑ NA
❑ NE
12128104 Continued

f
Facility Number: g2- 330
9-/5- vrl
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �41
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 L7No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes DNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [3 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,-.,�
9. Does any part of the waste management system other than the waste structures require ❑Yes U No El NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ko ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0'1�o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) e-iTw... j , (76 vc -A l l (f tV -..'
13.
Soil type(s) AM A—UG e- vi //C -
14.
Do the receiving crops differ from those designated in the CAWMP? El Yes
�
2 o
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
oo
[I,9 NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
9� oo
El NA ❑ NE
17.
Does the facility lack adequate acreage for land application? El Yes
E3 o
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
G o
❑ NA ❑ NE
Reviewer/Inspector Name Phone: /O- V.33, 3-33 y
Reviewer/Inspector Signature:--- Date:
Page 2 of 3 12128104 Continued

I - • •
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CTINo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ptvo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 9'9'o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking. ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LrNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q-Ko'
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C3-go-
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E- o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O'g!o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElC Yes
5o
❑ NA
❑ NE
29.
Did the facility fait to properly dispose of dead animals within 24 hours and/or document
❑ Yes
to
❑ 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?
El Yes
,�,
I_I - o
❑ 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?
ElE Yes
�
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D-<o_
❑ NA
❑ NE
Additional Comments and/or
12128104

krms' 9-05-08 ?-P-
I
.• i i i i i w m run i III■IlrnYl i nlnlnn�l� YIi Inln
tvision of Water Quality
Facility Number 0 2 .33D� 4 Division of Soil and Water Conservation
O Other Ageney
Type of Visit 015ompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of visit: -19 OS Arrival Time; %/,`x9 Departure Time: //,' County: SQ 1-4S4w Region:
Farm Name: `' Owner Email:
Owner Name: __ bus ,,,_,/ ✓ 42' Phone:
Mailing Address:
Physical Address:
Facility Contact: �yY s ��r�1 G Title: � Phone No:
OnsiteRepresentative: /'CLASS /'¢ram Integrator: 4f0A'zV/L
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = 0 „ Longitude: ❑ 0 0 ' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
9 2 Z S"L ❑ Non -La et
❑
Wean to Finish
Wean to Feeder
62
El
Feeder to Finish
El
Farrow to Wean
El
Farrow to Feeder
El
Farrow to Finish
El
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
El Pullets
ElTurkeys
❑ Turke Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [I Application Field [I Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
El Dairy Heifej
❑ D Cow
[INon-Dairy
El Beef Stocket
El Beef Feeder
El Beef Brood Co
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)?
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 ['No ❑ NA ❑ NE
❑ Yes
❑ No
L" NA
❑ NE
❑ Yes
❑ No�NA
❑ NE
LT NA
❑ NE
❑ Yes
❑ No
❑ Yes
2<o-
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

J
•tr .
Facility Number: 92 --3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural frceboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes El"No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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
ENo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Q- o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
3 o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Vo
❑ 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
El Yes
5o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�,N�
L7 o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,—,�
3 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 Drill ❑ Application Outside of Area
12. Croptype(s) �O�-l.�kcLOL $�[« rr,i`�✓ Co,S,
13. Soil type(s) Alo seV W C__
_
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
,�
D<o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9110
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]
Yes
2
El NA [I NE
17. Does the facility lack adequate acreage for land application?
El Yes
�oo
D o
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I,j'Na ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
��
AL
11
Goa aL P►ec3y `
G " 4
Reviewer/inspector Name �� L ['� e 5 Phone: Y�Or fQ3, 333d
ReviewerllnspectorSignature: 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 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Elio
❑ 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
E3 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Flo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0�o­
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ 0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes D o ❑ NA ❑ NE
Other Issues ,.,T�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElYes L5o ❑ NA ❑ NI:
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fo-
❑ 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
ElE
.,�
3 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
rI�
t_o_
❑ 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
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E No
L❑ NA
❑ NE
Page 3 of 3 12128104

1/
1 16
® Division of Water Quality ,
�-- 33 d O z �9 h
Factltty'Number' Dr+visi6n of�Soifgand Water < -A
,: .. N Q Othcr,AgcncY,
Type of Visit .0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /$-Q3-07 Arrival Time: Departure Time: �'�SY County: a'� Se Region:IF
Farm Name: RW QYkc Y A Y Owner Email:
Owner Name: RqSSeL>* �Qi'x�Y Phone:
Mailing Address:
Physical Address:
Facility Contact: eu+')� S" aar w � c k Title: /# Phone No:
Onsite Representative: 6�kt-5 f3a�'W arc: K _ Integrator: CoLraKI e- /G-'Vol s
Certified Operator:
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
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0 6 Longitude: = ° = I = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er T I —=l
992Z I 47YO ' ❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current:
Capacity Population."
i,
❑
Daia Cow
❑
Daity Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non-Daity
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures: ©i
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 [P No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
W No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
12128104 Continued

ir . .
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[XNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[8 No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�A No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
EN No
❑ NA [I NE
maintenance/improvement?
11, Is there evidence of incorrect application'? if yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) Crwfu/j <;RtrN
T
Kos)
^
13. Soil type(s) )C;..B Ao A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ 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
;M 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
P No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 'k Q e v 2 Phone: 'M9. �13.3, 330 D
Reviewer/Inspector Signature: � Date: 14 —os — Zo o 7
12128104 Continued

ar . .
Facility Number: S2 -3301 Date of Inspection /0-03-07
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 appropirate box. ❑ WUp ❑ 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 V Rain Inspections ❑ Weather -Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[Z 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
❑ NA
❑ 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 properly dispose of dead animals within 24 hours and/or document
❑ Yes
[0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(M No
❑ NA
❑ NE
al Comments and/or
12128104

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I 5-0c?-661 Arrival Time: /I Departure Time: County: _. 03j"'Q:re 04
Farm Name: %31d :E5 e'%l Yn- 4- Owner Email:
liwnnr Nimmo• /\ iA 3.5 e— 1�G�11/��ra t/ Phnnp-
Mailing Address:
Physical Address:
Facility Contact: t`�LlSsc.�� /''L�l�i��r 'Title: Phone No:
Onsite Representative: � � S UGTIr(,tOrcK �G�fSt'��/zyK+Y Integrator: 0bla1'-1lc_�
Certified Operator:
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
Operator Certification Number:
Back-up Certification Number:
Region 1_51-U
=o❑'�� =o=t
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Z� ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharizes & 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?
Design Current
Cattle Capacity Population
❑ DaiEZ Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEX Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures: E3
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 [ANo ❑ NA ❑ NE
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
N No
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
Q0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 97--330
Date of Inspection -v8-c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
.Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T3
5. Are there any immediate threats to the integrity of any of the structures observed`?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes % No
❑ Yes [gNo
Structure 5
[DNA ❑ NE
El NA [I NE
Structure 6
❑ Yes 2jNo ❑ NA ❑ NE
❑ Yes % No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes r7No ❑ NA [I 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I$ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) h?erjjj udo,G ,4u lr (ram 'r"
13• Soiltype(s) �ci-fa1K �tGev�'/%e�
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 q No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [XNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes f� No ❑ NA ❑ NE
CommeM11011.question #):. Explaip any YESranswers and/or any recommendations or any other comments.
Use draility to het�er explain. situations. (u additional pages as necessary};
5 : cx, " q!O T �. �
Reviewer/Inspector Name jG�, 1�-,u Phone:
e.V�.,�_-,' ?„
Reviewer/Inspector Signature: ' Date:
12128104 Continued

� v
Facility Number: FZ —2z72d Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes Q�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes W No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes p 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 ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the pen -nit?
❑ Yes
0 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
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[rMNo
❑ NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
6 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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 duality concern?
❑ Yes
�No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
N 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
O&No
❑ NA
❑ NE
12128104

Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit' @ Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: D� c?3no Arrival Time: g:,3v Departure Time: County: ��tQJ-+ Region:
Farm Name: /` u ss C_ c or, Owner Email:
Owner Name:_ Phone: 9/0 , 31iG�-
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Z& <sg__ a
Certified Operator: !Snu _4s // a r���
Back-up Operator:
Phone No:
Integrator: C0 ra
Operator Certification Numiier:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = 4 = Longitude: = o = 1 =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
� ❑Non -La er
❑
Wean to finish
❑
Wean to Feeder
®
Feeder to Finish
Q .?D.S
Poo i
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy E-leifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of YStructures: [Ell
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'? (lfyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

facility umber: P - 33ol Date of Inspection 9 ?3 0
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): c DO. 4 `d
Observed Freeboard (in): 37 If
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markets 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
R1 No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[§ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) de e." "..Pd %{au
13. Soil type(s) IVOfi 6t/,4 %Xie
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(O No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CZ No
❑ NA [I 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
[2 No
❑ NA ❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Comments {refer to questio#)� Explain any, YES answers andlor any recommendations or any other comments.
,.
se drawings of facility to better explai ituations (use additional pages,, s necessary,);
IN-15 _A`x;�, x.$ ,3:..:>• firo-:balif{a''J;
Reviewerllns ector Name Phone:
Reviewer/Inspector Signature: Date:
C-7 12128104 Continued

Facility Number: 9.2 - 33o Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9No ❑ NA FINE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El 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 M Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
U 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
m NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
© No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
59 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
9 No
❑ NA
❑ NE
Addltlonal Comments;arid/or Drawings: -
�r
1 rroycaQ.
Cp.1.�Y0���or. av,o9� S11ti��t. e.Lkvve� trleCd2t kv C CJ�DT�G L.�st#��N
12128104

of Visit (Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (W Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 6�' Time: '' �
p
Not Operational Q Below Threshold
© Permitted 0 Cerdfied 70 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ..................
FarmName: ...... �!p`. ��...... Coup? o...........!`!........................................................ County:....5 r A:!........................................................
OwnerName: ......... R!ti �l........i..4:k4......................................................_................. P//h��one Na:.......... ...
.........57 �.r .............
MailingAddress: .... ...Lsa!P......... ..... C��....lea,................................. ....6hol m.,,,..........,N..�...................................... . a J .....
Facility Contact:...........t l�..... arXeQ ............................ Title:..... b.w.aA....................................&L""Irt
Phone No:...................................................
Onsite Representative: ,, ,,,,,,,,, !'w is K Integrator:
Certified Operator: .. I .R.4 1�.......! arlt�,t Operator Certification Number:....... 111A.1 ...................
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 66 Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes GZINo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E3"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [2'I Io
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idcntificr:.......... ........................ ................................ .. .................................... ................................... ......................................................................
Freeboard (inches): i
12112103 Continur:i

Facility Number: Sj;. -- 3 3 D
Date of Inspection �o
5:'zAre there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes B No
❑ Yes [TNo
❑ Yes B No
❑ Yes [91�0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [ENo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [�Vo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [IFrozen Ground ❑ Copper and/or Zinc
12. Crop type 4 /
. Me f avusrt,l)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? []Yes 21go
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 2Vo
b) Does the facility need a wettable acre determination? ❑ Yes B No
c) This facility is pended for a wettable acre determination? ❑ Yes [allo
15. Does the receiving crop need improvement? ❑ Yes v❑'No
16. Is there a lack of adequate waste application equipment? ❑ Yes BNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes B10
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes G No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 2No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ZNo
Air Quality representative immediately.
,.. .1lL:ii41L'. Ie.._ ':"•,•-`.11i'Ii1.Ah.,•_`•.•�'1:=1!i�'.i7�Ti'iilid:ll€ii. :l21i3".""'715� I-sC3ii>q;Wi31;lU'V. ;:>',."4SdRV:.•"Jve•: ^'.ilP{
[ri 1 3 €
eComments!(refer to question #)s' Ex'plsiin�any;!YES answerslgnd/or'anyirecommendations
3: -
..n'ti1!,,,i"r.l:is}i I.r .;i€yl'•'!Il €Iwo;:u:>a:'.FAI'1 -.1.,;P,f:.;•1r
i4 u<si 3'f 4Fe E3 -:F2{;-:I.lt:l�.i11,k�...4fi§iilib�sl-1€; !:, -$. 5!iMcf - t '3;-,,.-.0
orany other comments: �33 };! I i>!v' !;,4,,:
l..fc,.:,...._il�.
�;;
t :;3:+€ .,4111ia€n, P.t- ;:�, , _.,a I,�,�-4€!`trY: :s„i:i1i ;.i�1€ ,l11"a€;
rT�:il i fl{ !' �bJtH-rrr., rl 1P sir �1•r....
i.Use drawings of facility to betterttexpiarn situations. Oike additional;pages as necessary)•
hWIN} V I .iN '1}
' i,
a
[Meld Copy Final Notes ,ti i11'Ij�
I C" IG .:'!i
nLlt lr.tir."-i_n.r,ll._.IYNiit �.i_c.:�3•,iiu :k_.._.:�.,.€,..lili'..i�,ua 1lflltti.nlllptliP'�7�tc':i <n..i...��€3(_3,rl�i._,3:r.,Ua.1;��it_,cr...lf}..rE,._?1L,..,l,
h f,s 11� h li: r 3
r11�#if?n7 c.7..! L Rol. 1..1 F.r.lila,i,.l�: a,,,,;,1„hi:�!
Td s� o� en A 4—A.
jp4
a ��-hrjC w� tfi..y}ard +N 5 `tie Id bit fo,�rs �.+� . ��eoKrSuds bcc.t hc+Ks`FCd j,�ir
ff
' z•„- !r
I'rReviewer/Inpector Name 1, z!
JSL F�,N
x.,n.L%; .�..�A1 _v
Reviewer/Inspector Signature: Date: CJ 00 0
12112103 U Continued

FaVili,Number: - 3Se Date of Inspection 7o a
Acquired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes G(No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ErNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes eNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
B No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
ErNo
27, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
QrNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
dNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ERNo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

1
ANIMAL
WASTE MANAGEMENT PLAN CERTIFICATION FOR EXISTING FEEDLOTS
Please return the completed form to the Division of Environmental Management at the address on the
reverse side of this form.
Name of farm (Please print)
Mailing Address: Y9
9='r3-1K rllunc INV.: Q [�
County (of arm): S ,4,n sc
Farm location: Latitude an Longitude: -]f� i` ed2 y5'� 35° os' � (required). Also, please attacha
copy of a county road map with location t enti .
Type of operation (swine, layer, dairy, etc.) _ '�w,',e
Design capacity (number of animals) : -2,2 0 S" Trri:,-
Average size of operation (12 month population avg.):
Average acreage needed for land application of waste acres) :
-----------------------------
Technical Specialist Certification
As a technical specialist designated by the North Carolina Soil and Water Conservation Commission pursuant
to 15A NCAC 6F .0005, I certify that the existing animal waste management system for the farm named
above has an animal waste management plan that meets the operation and maintenance standards and
specifications of the Division of Environmental Management and the USDA - Soil Conservation Service
and/or the North Carolina Soil and Water Conservation Commission pursuant to 15A NCAC 2H.0217 and
15A NCAC 6F .0001 - .0005. The following elements and their corresponding minimum criteria have been
verified by me or other designated technical specialists and are included in the plan as applicable: minimum
separations (buffers); adequate quantity and amount of land for waste utilization (or use of third parry);
access or ownership of proper waste application equipment; schedule for timing of applications; application
rates; loading rates; and the control of the discharge of pollutants from stormwater runoff events less severe
than the 25 - year, 24 - hour storm.
When checked, see reverse side of form for conditions/exceptions.
Name of Technical Specialist (Please Print): Ck.&r
Affiliation (Agency): o l& rn Fes.... s
Address (Agency): n do -,4,,, Phone o.: 7 D
Signature: Date:
Owner/Manager Agreement
I (we) understand the operation and maintenance procedures established in the approved animal waste
management plan for the farm named above and will implement these procedures. I (we) know that any
expansion to the existing design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of Environmental Management
before the new animals are stocked. I (we) also understand that there must be no discharge of animal waste
from this system to surface waters of the state either directly through a man-made conveyance or through
runoff from a storm event less severe that the 25-year, 24-hour storm. The approved plan will be filed at the
farm and at the office of the local Soil and Water Conservation District.
Name of Land
Signature:
Name of Mann€
Signature:
owner trtease p
ate:
Date:
W
Note: A change in land ownership requires notification or a new certification (if the approved plan is changed) within 60 days of a title transfer.
.6 -P C/', �"
DEM USE ONLY: ACE#
a���dX �'�r1� . err... w: I► � a.. ��.��
Ce

CONDITIONS AND/OR EXCEPTIONS TO CERTIFICATION E
All statements checked apply to this certification:
The installed irrigation system has not been evaluated concerning nozzle size, spray pattern, spacing, pump size, pipe size,
etc. It is the responsibility of the producer to operate the system with the proper components and to supply the required
maintenance to assure that no runoff occurs. The producer is encouraged to have an irrigation specialist, possibly the dealer
where the system was purchased, prepare an operation and maintenance plan for the Irrigation system so that the producer
knows how to operate the equipment to meet the non -discharge requirements.
The waste management plan for this operation is based upon yields higher than what is now recommended by NRCS;
however, these yields are obtainable under high levels of management. This increase in projected yields is necessary since
the NRCS plan prepared for this operation at the time of construction was based upon these higher yields and the producer
followed NRCS guidelines when building this operation.
Because of limited acres for Iand application, and because the original NRCS waste utilization plan did not require
additional acres for buffers and irrigation inefficiency, it may be necessary for the producer to operate half sprinklers, on
solid set systems, along field edges and ditches. Also for traveling irrigation systems, a pull directly adjacent to the ditch with
only a 180 degree pumping radius may be needed to irrigate the entire field. Extreme caution should be exercised when
applying waste close to ditches and wetlands to avoid any discharge.
J �1'w+ttr has CLCc?SS 4-0 TC' e%m-Pen C!,F
CERTIFICATION FOR EXISTING FEEDLOTS
INSTRUCTIONS FOR CERTIFICATION OF APPROVED ANIMAL WASTE MANAGEMENT PLANS FOR EXISTING ANIMAL
WASTE MANAGEMENT SYSTEMS SERVING FEEDLOTS
REQUIREIVIENTSIPLMPOSE
In order to be deemed permitted by the Division of Environmental Management (DEM), the owner of any existing animal waste
management system constructed and operational before January 1, 1994 which is designed to serve greater than or equal to the animal
populations listed below is required to submit a signed certification form to DEM before January 1, 1998. Pasture operations are exempt
from the requirement to be certified.
100 head of cattle
75 horses
250 swine
1,000sheep
30,000 birds with a liquid waste system
The certification must be signed by the owner of the feedlot (and manager if different from the owner) and by any technical specialist
designated by the Soil and Water Conservation Commission pursuant to 15A NCAC bF .0001-.0005. The technical specialist must verify
that all applicable operation and maintenance standards and specifications can be met. Existing systems are not required to meet design
and construction standards and specifications.
Although the actual number of animals on the facility may vary from time to time, the design capacity of the waste handling system should
be used to determine if a farm is subject to the certification requirement. For example, if the waste system for a feedlot is designed to
handle 300 hogs but the average population will be 200 hogs, then the waste management system requires a certification.
This certification is required by regulations governing animal waste management systems adopted by the Environmental Management
Commission (EMC) on December 10, 1992 (Title 15A NCAC 2H .0217).
CERTIFICATION FORM
On the reverse side of this page is the certification form which must be submitted to DEM before January 1. 1998. Assistance in
completing the form can be obtained from one of the local agricultural agencies such as the Soil and Water Conservation District, the
USDA -Soil Conservation Service, or the N.C.. Cooperative Extension Service. The Completed form should be sent to:
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section, Planning Branch
P.O. Box 29535
Raleigh, NC 27626-0535

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Site Requires Immediate Attention: Ng_
Facility No. 8 1-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -XI Z-, 1995
Time:
Farm Name/Owner: us s l l �- �4•-k k �4 •�
"Mailing Address: Lkqc. �q� '�ra� I.a � . �'��•. N � 'ua 3 z�g
County: AMP ---.a N
Integrator:-- Ca t{ A %t s - -- _ Phone:
On Site Representative: R,-sscAV 'Porker Phone: SW-t - T000
Physical Address/Location:_ _ kx:5 4t Lt N of ct. •.f.., p-rk—
C°Vno.r.._ \,d%ck .►.w Cz-w.3rft-r
Type of Operation: Swine _
Design Capacity: a-zo 5
DEM Certification Number:
Latitude: "
Poultry Cattle a0=0W
Number of Animals on Site: V-_L_ I-ro F4-ckt.r to
ACE DEM Certification Number: ACNEW
Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from they n(s)? Yes or 1�o Was any erosion ob ed? Yes o No
Is adequate land available for spray. Yes r No Is the cover crop adequate.Uesor No
Crop(s) being utilized: f C--rs 3P c.0.Y..%0%
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' es or No
100 Feet from Wells? Ye or
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes org
Is animal waste discharged into water of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate was management rec (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Qej or No
Additional Comments: t wit
-V, _a t r1S
i I/4 AC\1 10.5vr,L
cx,f k-.El4LC1
M-,twLt. W "V",
Inspector Name
Signature ^
cc: Facility Assessment Unit Use Attachments if Needed.