820521_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: 40 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: t® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: W :Ah_ I County:
Farm Name: 0 SS &,P_4 Owner Email:
Owner Name: lzSS &nQ Phone:
Mailing Address:
Physical Address:
Facility Contact rJ �f Title: Phone: rr
nmite Renrecentative!� Integrator:epy
Certified Operator: L Certification Number: �b V
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region: )5790
Discharges and Stream�a4��
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 TNo ❑ NA ❑ NE
❑ Yes
Design Current
�g NA
❑ NE
[—]Yes
❑ No
Design Current
Design Current
Swine
Capacity Pap.
Wet Pointry
Capacity Pop.
Cattle Capacity op.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Laver
Dai Calf
eeder to Finish
p
Dai Heifer
Farrow to Wean
Design ,urreat
Cow
1
..
Farrow to Feeder
L . 1YOu-, - - ii . LCa aci BYO .
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Tnrkevs
Other
Turke Points
Other
Other
Discharges and Stream�a4��
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 TNo ❑ NA ❑ NE
❑ Yes
❑ No
�g NA
❑ NE
[—]Yes
❑ No
NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
Q2 NA ❑ NE
0 N ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

Facility Number: Ce>5P- Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? U Yes LNo ❑ NA U NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2
Identifier: I
Spillway?:
Designed Freeboard (in):
Structure 3 Structure 4 Structure 5 StrucLe 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ T
tal threat, notify DWR
7. Do anv of the structures need mnintennnre nr imnrnvement? 1--1 Yec Nn 1-1 NA n NE
- - -- r - � - .it.i - - L
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes [� No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes [� No [:] NA ❑ NE
maintenance or improvement? 1
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ro No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA
❑ 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 tnd,Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops
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 andior 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 nronerly oneratino wnste nnnlirntinn enninmenO
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑ Yes® No ❑ NA ❑ NE
Yec � No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tran hers
❑ Rainfall ❑ Stocking ❑ Crop Yield p 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes k9 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fa ility Nu her: y- Date of Ins ection: Z? if T
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
U 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?
2! . LIU the 'IMAILly IdIl LU SCCurc a phosphUfUS LUSS it"CSJ111CHLS (PLA 1) GCAt MIC:at1UM
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other-
❑NA [D NE
❑ NA ❑ NE
[] Yes
�No
❑ NA
NE
" Yes
IW 1VTu
LJ I'Z1
^❑
i— ' l�
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r
Date:
b?"
2141201S

Type or Visit: WCompliance Inspection U Operation Review U Structure Evaluation U "Technical Assistance
Reason for Visit: 4PRoutine O Complaint O Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: �,�]%�p%� Arrival Time: Departure Time: County:s�ri s�Region: FAD
Farm Name: 9 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: &4Certification Number: qn a�`l
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream aaaa�na.aa
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 DW R)
❑ Yes 'ONo ❑ NA ❑ NE
❑ Yes ❑ No T NA ❑ NE
❑ Yes ❑ No 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 DWR) [:]Yes ❑No � NA ONE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�PNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21417015 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11
INon-Layer
I
Dairy Calf
Feeder to Finish
Q
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D • Paonl
Ca aei
P.o
Non -Dairy
Farrow to Finish
I
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I Beef Brood Cow
77. ... _...
Tnrkevc
Other
Turke Poults
NJ Other
I 10ther
Discharges and Stream aaaa�na.aa
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 DW R)
❑ Yes 'ONo ❑ NA ❑ NE
❑ Yes ❑ No T NA ❑ NE
❑ Yes ❑ No 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 DWR) [:]Yes ❑No � NA ONE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�PNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21417015 Continued

Facffi Number: Date of Ins ectio
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo E]NA E]NE
a. If yes, is waste level into the structural freeboard? ElYes No J�q NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
o. Are ihere structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes
No
❑ NA
❑ NE
[j 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 anv of the structures near/ maintenance or imtnro _,ement?
r-1 Yes �ATn
!__I
TTM'
❑ XT�A
M
8. Do any of the structures lack adequate markers as required by the permit?
E]Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ Ivy
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
LrI ­
NA
u
❑ NF.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA
maintenance or improvement? r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ 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 A(
12. Crop Type(s):
13. Soil T-mPicl•11
❑NE
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
i6. 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 nronPrly nnerntino waste annlicarni
tinn ainmpnt?
o rr -t r -•--•••
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
VbNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ YesNo
❑ NA
❑ Ivy
❑ YesNo
�M�1—f
[:]NA
❑ NE
I-1 Yes
u
LrI ­
NA
u
❑ NF.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes jo No
El Waste Application ❑ Weekly Freeboard E] Waste Analysis ❑ Soil Analysis [:]Waste Tr sfers
❑ 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 N
Page 2 of 3
❑ NA [—]NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
No
❑NA ❑NE
2/4/2011 Continued

Fneili ' Number: - Date of Inspection: O LL
?4 I7irl the farility fail to ralihratP waste annlieatinn enninment ac n- nnirvrl by the nermit M Yec In Mn I --I NA n NF.
- - __ ___ __._---s ____ __ _____. ___ ..-___-rr_____.___ _1__r____�_ - __Z_____ _� ____ r --------
25. 1s 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ YesNo 0 NA E]NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ff"o
❑ Yes No
❑ Yes No
❑ Yes ONO
❑ NA ❑ NE
❑ NA ❑ NE
❑.NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes �5 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency'? ❑ Yes IM No ❑ NA ❑ NE
Comments (refer to question: Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional Dazes as necessarv). 2_ e.
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature: Date
Page 3 oj3
2 �o
Z/4/2011

r ype ui v ash: w uompnance inspeenon v uperanon xeview V mruciure tvamanon V i ecunicaa Assistance
Reason for Visit: *Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: 2 '(Q Departure Time: Z l County: �' " Y-�i ]Region:
Farm Name: _Xvv_ray- Ik^ Owner Email:
Owner Name: fA&*IP— ] � Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: U Q vy Certification Number: g 94 tj/
Back-up Operator:
Location of Farm:
a
Latitude:
Certification Number:
Longitude:
Dicrharaes and Stren— 1mno.fc
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)?
r♦_ T7necthe rlisrharae hvnncc the wade mannoement cvctPm7 t1fyec notify DWR)
...,�..,�
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes [—]No
[-]Yes ❑No
❑
1 Yes 1,,1 No
❑ Yes `— No
❑ Yes I No
NA ❑NE
NA ❑ NE
M NA
rI NE
[] NA
❑ NE
❑ NA
❑ NE
Page l of 3 2/4/2015 Continued

FaciliNumber: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C-1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No [3 NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) V
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo C:]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 anv of the structures need maintenance or improvement? ❑ Yes 10 No ❑ NA n NE
T"
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 T No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes T No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. p Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Cr p Window ❑ Eviden Wind Dri Application
Gtr
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): �1f' t --
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
0 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
❑ YesNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ YesNo
E]NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
1,=,1 Yes TNo
r
]❑ NA
❑ NE
Ree uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes EpNo
❑ 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 T- No ❑ NA [:]NE
E] Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr fers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23 if selected did the 4a`dity fail to +„all and nt-- „ br akP on irrination enuinme-? {—I V_� 11_Nn n NA I—I NE
..� ...., u .. ........ ......... ........... ..b.. ...y.. r• U L—J - u
Page 2 of 3 2/4/2015 Continued

IFacqity Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes o E] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes] No ❑ NA ❑ NE
'7n.A aL- l -A.' .. C :1 — _ �L __�L_�__ 1___ ______�_�._ f-, a m\ n r_1 v__ � LT_ r—E M A r__1 A1C
� I. L.Ju LII; iaL I I Ib' 14211 LL) bULMIG d J.1LIVJkpllU1 u] Mbb dbbUb�1ilG1LW kr Ltl l f t:m L11 lt;aUsil l! U L GJ 1'4V t_t jw%
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
narmit`7 [i a rlicrh�rna ir--I. � A nroomc - r.linn+:nnl
bl
1•�....... �. �., ............ b.., .. vv vv.., a. Mw.v�. , .wapy........v..�
1
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name:
Re•..+n'eriiijpector Jig`Ilatui
Page 3 of 3
Phone: C 0A_r_9 3
Datc: 4 l�� � IL
21412015

(Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
(Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv O Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: rYJa+ County:^1 RegionV`_x-II-r/
Farm Name: MI (I AL FTa,,,,p+1)f) T-1-,,rv, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
q
Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: pO Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Design Current
1E.esign Current
Design Current
Swine Capacity Plop.
Mt,Poultry = Capacity `: Pop.
Cattle Capacity Pop.
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
La er
Non -La er
nCurrent
Dai Cow
Dai Calf
Dai Heifer
Dry Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Farrow to Feeder
D PoulCapact ;: Po .
Non -Dairy
❑ No
Farrow to Finish
Gilts
ILayers
Non -Layers
Beef Stocker
Beef Feeder
❑ Yes
No
Boars
Pullets
Beef Brood Cow
❑ Yes
ME No
Turke s
❑ NE
_ ie d
I
VLI1G JLdLC VEller man from a discharge.,
Other =_
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[)A NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ME No
❑ NA
❑ NE
_ ie d
I
VLI1G JLdLC VEller man from a discharge.,
Page I of 3 2/412014 Continued

acili :Number: W;31
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �bNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [)J)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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
}
❑ Yes
No
❑ 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ 'r"es 1 No ❑ i -A ❑ i
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo [—]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 1p No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [PNo ❑ NA ❑ NE
."i.au.t�.uauee lar iaia}aria'r�iuiut?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1 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 ro�Za Evidence of Wind Drift ❑ Applicatio Outside of Approved Area
12. Crop Type(s): " iez�d,�) !! ",
13. Soil Type(s): M
A11K'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
[3 Yes
� No
E] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
IM No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesNo
[3NA
❑ 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 w, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �1 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T, No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Facili Number: - Date of Inspection: �t-
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 E3 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?
E] Yes
No
E] NA
E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
El Yes
�9 No
E] NA
NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
( No
❑ NA
NE
and report mortali- rate -c that were hiohPr than nnrmal7
TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
E] Yes
No
E] NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
No
NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes0
No
NA
C]NE
El Application Field ❑ Lagoon/Storage Pond E]Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
No
NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Yes
No
❑ NA
NE
34. Does the facility require a follow-up visit by the same agency?
E] Yes
No
[] NA
NE
Coni rents s of. fto qu t better explain any YES answers and/or any additional recommendations or anyto—e- comments.
m
sm6' n s (prefer to question#� - I I situations (use additional nes. as necessary).' z , ..
Reviewer/Inspector Name:
V n /1_
ReviewerMspector Signature: \. 1 k2tA)r
Page 3 of 3
Phone:
Date:
2/4/2014

r ype ui v Asn: W %,ompuance inspection tJ tiperation xeview v structure r,vatuanon t) t eennicai Assistance
Reason for Visit: AD Routine 0 Complaint 0 Follow-up _0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 'qp Departure Time: / County: fe9�f%Region: v�'
Farm Name: Owner Email:
Owner Name: &1V40Y Phone:
Mailing Address:
Physical Address:
Facility Contact:Title:
O.^.s:te Repr esentat::'e' % u /'
Certified Operator: U�H ] g
Back-up Operator:
Location of Farm:
Latitude:
Phone:
/%%////�%J
Integrator. A [ r� /
Certification Number:
Certification Number:
Longitude:
Design Current pe n �Curretit Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pap.
a..-
Wean to Finish La er Dai ry Cow
Wean to Feeder Non -Laver Dai Calf
Feeder to Finish 7.a 7.0 .= r -:: Dai Heifer
Farrow to Wean `T Desi n Ctrret Cow
Farrow to Feeder D—ryjP,ouI " . Ci aci Po 0. INon-Dairy
Farrow to Finish La ers Beef Stocker
Gilts Layers Beef Feeder
Boars Pullets Beef Brood Cow
Other ITurkey Poults
OtherIll 10ther
Discharges and Sirexm impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State ,(gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
[:]Yes ❑ No
[—]Yes [� No
[:]Yes No
rI NA ❑ NE
NA ❑ NE
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

FAcility Number: Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 01 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0§ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): U
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 [ 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
[�TNo
❑ 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 Apylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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 Dri€i Ap lication
Outside of Approved
Area
12. Crop Type(s): S dL.5 C rG.
13. Soil Type(s): D 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
Efl No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesNo
1P
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Flo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
IP No
T
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
allo
❑ NA
❑ NE
20 liner the fnrility fn; Ito ha .11 M.rmm�nnant¢ of the f`AWK4PAl.'P 1;l.r otroilohlo] If vac A—A,
1_11 .0the
�l Vac
ri'1. Un
1'I NA
M NR
appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps p Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA
❑ NE
U Waste Application Lf Weekly Freeboard U Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[3Rainfall ❑ 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
PNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
LJNA
ONE
Page 2 of 3
2/412011 Continued

IF,acilityNumber: jDate 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 [DNA ❑ 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 PNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes y No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes T No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 4Z] No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.,or. any other comments {
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: %
21412011

(Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance 1
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 EmerEency 0 Other 0 Denied Access [I
Date of Visit:'11MI Arrival TimerDeparture Time: /?��V. County: p1J Region:
Farm Name: Owner Email:
Owner Name: Ni{L( �- Law Phone:
Mailing Address:
Physical Address:
Facility Contact: DY4M10-ac-4i
c0-aTitle: Phone:
h
Onsite Representative: Integrator:(�,lp -UjyJ
Certified Operator: ao" h V t B 11
45L630a Certification Number:
Back-up Operator: 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 ma--=m---Ie"
"
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system! (if yes, notify DWQ )
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes U No
❑ Yes MNo
❑ Yes No
ivA ❑ VP
NA ❑ NE
NA LJ 1-4r,
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued
g CP int
acn
Design Current
5wme
Ca Pot Wet PoultryEDoiig�
op# ��Ca�1
e Capacity Pop.
an to Finish
r
+La er
Da' Cow
an to Feeder'
der Finish
Non -La er
"'`
Dai Calf
to
ow to Wean
y
Design Current -
Da" Heifer
D Cow
to Feeder
IJ . P,oul Ca aci P,o.
Non-Daow
!,Farrow
to Finish
La ers
Beef Stocker
s
Non -La ers
Beef Feeder
rs
Pullets
Beef Brood Cow
Turke s
Turke Poults
er
...
Other
_... .e,, ,.-._T Lim --+.i.... ♦ _�iUiiPY���
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 ma--=m---Ie"
"
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system! (if yes, notify DWQ )
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes U No
❑ Yes MNo
❑ Yes No
ivA ❑ VP
NA ❑ NE
NA LJ 1-4r,
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

` Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�d No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
[-]No
V NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
U NA
i
Identifier:
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
eW
No
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�DNo
❑ NA
Designed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
❑ Yes
y No
❑ NA
Observed Freeboard (in):�
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
1PNo
❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
No
P1
❑ 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
[n 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 anv of the strnetnrea need maintenance or imnrnvPmPnt9
. - - I -- --- --------- ---- -------------- -' ----r--' . _--------
M Vpc
---
n Nn
M NA
M NF.
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
`Pi° No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need
❑ Yes
"No
[:]NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [-]Yes [�PNo ❑ NA
❑ 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
12. Crop Type(s):
13. Soil Type(s):
❑ NE
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 faciiiry fail to secure andior operate per the irrigation design or wettable
❑Yes
No
U NA
Ll NV_
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
eW
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�DNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
y 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
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes
�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
1PNo
❑ NA ❑ NE
Page 2 of 3
214/2011 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 11--0 No ED NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,Zj 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:
2b. Did the facility fail provide documentation of an actively certified operator in charge?
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑Yes
0 N
❑NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ij No
❑ NA
❑ NE
❑ Yes gg No ❑ NA ❑ NE
❑ Yes "q No ❑ NA ❑ NE
❑ Yes K]No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1�4 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes a No ❑ NA ONE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes K No ❑ NA ❑ NE
Comments (refer to question#a') Explain any YES answers and/or any additional recommendations or afiy other commen
ryets.
...
lu'se,drawings of faciItty; to;better explain situations (use add tionaLpages as necessary).' '
�Ict j� fa,_Y�7
X_
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: U -Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: '6 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: Departure Time: i� County: Region: �Q
Farm Name
Owner Name:
Mailing Address:
Owner Email:
Phone:
.1— 5I
Physical Address: 4X(0 5V
Facility Contact: �`'r.ihW'6(_ Title: Phone:
..Jt� n
Onsitee Representative- — _ � "..'_ j N"/1. �0"� 1..40.. r.,4nr• !`7�l•f a
Representative-RAQ v • W 4aw 1 .a. a�.nava. r r
Certified Operator: nnu Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current _.a izQign Current
Design Current
Swine Capacity
Pop.Ve t Poultry _ Capacity Pop.
Cattle Capacity PoP.
Wean to Finish Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to FinishY'-'*��
Farrow to Wean
,_ �-
-��
� ';Design Current
Dai Heifer
Dry Cow
Yarrow to Feeder 'D 'P.,oul PCa acit�P,o Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
T­l.a..,-
❑ Yes
Qthe
ey Poults
❑ NE
Other
Other
[3 No
uiscu„r ra u►1u dream impacts
L Is any discharge observed from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EX -No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2011 Continued

` Facili 1y Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N ' o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ 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 LN No
❑ NA
U NE
waste management or closure plan?
LJ Nt=,
15. Does the receiving crop and/or land application site need improvement'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7 lin any of the crrnrtnrvc naerl main tenanra nr imnrnarament7 '�tY Vac rl Ain
.. -tL.. .. ...aint......nce .,.....Y..,, �........ If . � U . ,
M M A
u ....
rl NP
LJ . .
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes tRNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
acres determination?
9. Does any part of the waste management system other than the waste structures require ❑ Yes W No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
® No
Waste Application
❑ NE
19. is there a lark of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®-No
❑ NA
❑ NE
maintenance or improvement?
Re uired Records & Documents
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1�;-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ Yes
CR No
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
�ZNo
12. Crop Type(s):
ISI. Uo the receiving crops dater trom those designated In the CAW MP?
U Yes
L4 No
U NA
LJ Nt=,
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
LJ Yes
W No
U NA
U NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
19. is there a lark of properly operating waste application equipment?
M Var
PS -,I Al.,
rl NA
n NIP
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements ther:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes X No
® Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1?3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
ErNA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �R No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑NA ❑NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
❑ No
U NA
❑ NE
C] Yes 5 -No ❑ NA ❑ NE
[:]Yes r -No ❑ NA ❑ NE
❑ Yes [5� No ❑ NA ❑ NE
❑ Yes Rt No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [NZNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 0 No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes fo No
❑ NA ❑ NE
NA ❑ NE
NA ❑ NE
Comiinents'(refer to questionft Explain any YES answers and/or any additional recommendations-oraan)other comments n° ._
Use drawings of facility to better explain situations (use additional pages as necessary). {
e e mylt a, a 'A?w 4e Y66
P, ���� S t n 1 R teas O['i'91G� t 'CIoPCyC%
Son le- WAC Rd P�
eoe Call r-a� e- &a yr yed r,
�e s✓ve ccay�&7 Lr) 00M
j
(awd I cord!,
plege t,,, p down
wads Far j �'� 1� � �
P[Ad�e rmo� h F' _
r
Q� (� }q r 'SO4'Foy l iyne r 4frfl�► v� 2,1 IC Vvlc'aol o �S'o�•r
11
K ham lo0o ea -s �, fti tree a 101` legs
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: CUAZ2 3I�P�
.J
Date: {}C� 1
2/4/.2011

Facility No. �a_ S� Farm Name )144 &W Date 14 11 .
Permit COC OIC NPDES(Rain breaker PLAT Annual Cert)
FB
Dro s
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in a
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibrati6-n—Date
Actual • Resign Width
i i'-------
Soil Test Date0—ULPWettable Acres RAIN GAUGE
pH Field $ ,,,� _ WUP ;� Dead box or incinerator
Lime Nee i�� _ Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu -I Zn -I 120 min Insp.
Needs P Weather Codes
Cron Yield ✓ Transfer Sheets
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
C a I
N �r/
C _ 4 � phi. kor v
t + -
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Qat Date last WUP at farm
FRO or Famf Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac
App. Hardware

0 IHS U/1 II laq to
Type of Visit laCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason s_ �r._ Of o...s:., r1 rr. .,�� .,t P1 rou_ !l o, s. �� ! 1 �... fl Rah„ ii n.. Ra A..
Reason O 10 sit MV Rvutl.na v _om.pla, .. v V low up v R��er�.1 V �u�erye���� L/ Otho 1F .,.�n�...-........�.�
Date of Visit: Arrival Tim,: `� � Departure Time: County: S Region:
Farm Name: Gre_�t Owner Email:
Owner NamH.{e: } t B&e(w+ Phone:
Mailing Address:
Physical Address:
Facility Contact: __H1 k b� Title: &A?,' Phone No:
Onsite Representative: Hfkk ar?foQt Integrator: `
Certified Operator: an hylu Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1--] V E__1 I ED 1
1 Longitude: =0=6
°=6 = u
aras4.�wa Cc�.x .Ill enii� �u�jl:{4tJ
1. Is any discharge observed from any part of the operation?
❑ Yes
(9 No
Design Current
❑ NE
Design Current Design Current
net
Poultry
Capacity Population CattEe Capacity Population
ish
❑ La er
❑ Dai Cow
der
r�a7rro
❑Non -La er
❑Dair Calfish ❑ Dai Heifer
❑ D Co.�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ean
.... a _
I i, Ukl
ers
❑ Non -La ers❑
1_I 1.4vll-vaftLa
❑Beef Stocker
❑ Beef Feeder
Finish
kFE
Pullets
❑ Beef Brood CowlTurke
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
s
❑ No
❑ NA
❑ Turke Poults
2. Is there evidence of a past discharge from any part of the operation?
Cl Yes
IMOther
Number of Structures:
aras4.�wa Cc�.x .Ill enii� �u�jl:{4tJ
1. Is any discharge observed from any part of the operation?
❑ Yes
(9 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Cl Yes
VNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
S:No
❑ NA
❑ NE
other than from a discharge?
12/28104
Continued

,Facility Number- — Date of Inspection
❑ Yes
EjrNo
r
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste C.oiiection & Treatment
❑ No'
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes.filo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 2 St mctu e 3 Structure n
Structure
5 ct„uctuTe 6
Identifier:
❑ NE
18. is there a lack of properly operating waste application equipment'?
Spillway?:
M&o
❑ NA
Designed Freeboard (in):
Observed Freeboard (in): e
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5?No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
1'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
UNo ❑ 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
J�ryes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5kNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9 N ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN n PAN > 10% or 10 lbs n Total Phosnhoniq n Failure to Incomorate Manure/Sludge
into Rare 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
EjrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
19 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
10 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment'?
❑ Yes
M&o
❑ NA
❑ NE
Comments (refer to question €): Explain any YES _answers and/or any recommendations or any other comments .
Use drawing of.facility to better e� lain situations' use additid-nal a es. as=n ces�sa }
P ( 6•,
.���
P >a
(q (o) LL33-330009- ?
(ajo)
Reviewer/Inspector Name `� .. Phone:
�D ` s U'E
Reviewer/inspector Signature: Date: V a
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo [INA [INE
the appropriate box. ElWUp El Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 62 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
f5kNo
❑ NA
❑ NE
a�I Exi6mfI- -(�&n s[udye swvf-1 ao�
10 000 bieo(e_ wi"njer.
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
5& NT
PRNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus toss assessment (PLAT) certification?
❑ Yes
❑ No
P NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CR No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
'2A
✓V.
At tl.e :...,...c.L_ :_.._�_.:�_ .7:.7 .t_
n 11 1 v1 UlG IIIJtIGG I UIU L11G l[1G1114y }1VbV aU UUU1 Ul d1_L t4U41111y GVl1GG111!
tJ Yes
L2g No
tJ NA
V Nt
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
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'in
.yc.
r1:.1 n__.. ___.__!r_____.__ r_�t ._ s'______ ____�____'�_____ __.�_ _ _.•n. _ _ _ •. . .• n
vlu Ixe rieweLitlispec IUi 1"dll LU LLIJl:LLJS ICVIC WllE15pCL"LIUII W1LR aR UR-S11C repreSCRlaIlVC.'
t—t X1__
LJ 1 w
'�/'l.i,.
hmw 11U
M ATA
L i Z,I 1
F1 ATL'
L..J
33.
Does facility require a follow-up visit by same agency?
❑ Yes
"RNo
❑ NA
❑ NE
Additional Comments and/or Drawings: M_
cl, a path a1 ve-yoozL �I I oon clidsP117
so if c.o/k t ti et-tt Ch a lot wlaPdJ , p Fie
Olid- re_sQ ff-' Aece. w [,lm f- wos app"&(/7 5 r I
a�I Exi6mfI- -(�&n s[udye swvf-1 ao�
10 000 bieo(e_ wi"njer.
H,
Page 3 of 3 12/28/04

. Facility No. _Farm Name vhf b` Date 11 bL
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert)
Pop. Design Current FB
Type Drops
Lagoon 1 2 3 4 5 fi 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth !ft`
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
E,FA of, on Ad a 0(Lt
KIIII
ctual
Design
Soil Test Date Q 3�L10q
pH Fields
Lime Needed
Lime Applied_ i�. a
Cu -1 Zn -14j"
Needs Piles
Crop Yield
N Amt—(lb11 000 Gal)
5-"0-�y,ettable Acres
Mtt ?*Up
llama Lewy Weekly Freeboard
1 in Inspections
! 120 min Insp. ✓
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
13 N 0
Verify PHONE NUMBERS and affiliations
Date last WUP FRO ��� Date last WUP at farm App. Hardware
1 rr !
FRO or Farm RecordsI10 lov �G�"� ji'If- C1 mo-k�" �a
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 Ib/ac: Zn -I 3000= 213 lb/ac

K
� 0 "bo lwK
� � _ cps

TVA 6IMJ ►011410q
Type of Visit
IS Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Rea s_- ai:_
Li Routine r1 Co
it F01110 Pl Re ft �! (1 EEm
/-1 lNL.. h r i. ..d Ac
plaint
noa3vi, w, r�aii ,w..u,ic V �..v,T,p.o...a
v . vnv�i iifr v ,�c,crra, v a_nwr~ycncy
v vu,c. u—cn.o.a .-...C�aS
Date of Visit: Arrival Time: Departure Time: County: Son S �!'} Region:
Farm Name: 11ei k p - Owner Email:
Owner Name: Nor ��Y O Phone:
MailingAddress:
Physical Address:
Facility Contact: r ► r �t -Title: L'''nqt Phone No:
Onsite Representative: �'i �rl ;tJfA.t?T Integrator:
Certified Operator: Operator Certification Number: AWA 9X.40
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 [=d =it Longitude: = o = g =5d
Design C►urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry. Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
Van to Feeder
❑ Non -La er
❑ NA
❑ Dai Calf
der to Finish
❑ No
[1 Dairy Heifer
❑ Farrow to Wean
_
Dry Poultry
❑ Dry Cow
nF.,.-.,., +_ 17--A �
,__, . a.,,..... w ..,.....,
a
❑ Layers
r1 ,.T__ r, .
L_j ilvi�-vail
❑ Farrow to Finish
❑ Beef Stocker
❑ Gifts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Uther
❑ Other
❑ Turkey Poults
❑ Other I
Number Structures:
of
Dis..h r....s & Cal -..am Aimp....r,
as cw s .aaa cane ■aa. a.oa,aa
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge!
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 15allo
❑ Yes Jallo
12/28/04
(I NA El NE
❑ NA ❑ NE
Continued

acility`Number:Q — Date of Inspection 13
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JRNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
�n
Designed Freeboard (in): I `�
Observed Freeboard (in): q�K
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JgNo ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed []Yes
IRNo ❑ NA EINE
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 amental 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? _?f6ma7Yes
Cg No ❑ NA [:INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes
RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
10 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy 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 ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Co 0t+a 1 tem vda +7o tL _ S IJ ey
13. Soil type(s)
0
j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JgNo ❑ NA ❑ NE
--_ 1q77n [--�
15. Does the receiving crop and/or land application site need improvement? EJ Yes t^1 No lJ NA EJ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 10 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes RNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes RNo ❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommends or any other,comments.),
_ � �, . .� - -,
Use drawings of facility to Better explain situations. (use additional pages as necessary): i
Reviewer/Inspector Name Ip�J �SC�.� ' y t Phone: (9)i311%x�
Reviewer/Inspector Signature: Date: G` CLCL-
12128104 Continued

Facility Number: (RA Date of Inspection 13 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No [INA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2 No ❑ NA EINE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E;�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
UNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25
Did the fariGty fail to rnnAnct n Onfirre cnrvev ac rertriireri thv tha nrrmiO
n vec
,0 Nn
n NA
n NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'�g No
❑ NA
EINE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
r1a6 ■
vaner Issues
ams c� 7
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9No
❑ 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
CNo
❑ 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
BNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
,rald tonal Comments and/or Drawiggs: - -.
- Y I,66 e seed o4d m,,(C% bars if otj a ray ore) n/a l L9
`
On S14 �i�d�e in.a.� cry-cr�rva &/"'q oLe bile .��� ate. loQd..
S
41� 13 aojA 0GOVj iq rer f
_ A � ,,,,t'_ A rNA%A `r�,rto APId-s Kaye sine been �arvP���
d s- cel i✓r k -eat G1� t//
S
QxF� oil �F ofx� SUIV-7; J t"
��°
Not rn�� lh -his o d tee f0 w �a00 )�� eJ>✓�n a-��
� �.y �
s� � add i���r�
N1�C� �rn !`0✓£m�il`� �'�en7-C,.i�q�n� ca�fkrh�����r �
ams c� 7
12/28/04

* Facility No_ Farm Name H,�� l� Date
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert }
Pop. Design Current FB
Type Drops
f
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ftN Q
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date ;nb`i 2 3 4 5 6 7 8
Design Flow
Actual Flow $
Design Width
Actual Width
Soil Test Date�
pit Fields
Wettable Acres
WUP
Lime Needed
Lime Applied
Weekly Freeboard L/
1 in Inspections
Cu -1 Zn -1
120 min Insp.
Needs P _
Crop Yield �� _
Weather Codes ✓
Transfer Sheets n
. II
N Amt (lb/1000
19: •.
RAIN GAUGE -�
Dead box or incinerator
Mortality Records
Pell/Field
Soil Crop RYE— Pftit} Window
Max Rate Max Amt
/SG -S'P C��-M�
i7J �l
ff^� _�a��
Verify PHONE NUMBERS and affiliations $a f J dJ 1 C'F
Date last WUP FRO Riaail? eEL3bs10 Date last WUP at farm App. Hardware
FRO or Farm Records �� ��� U Le
a4 �aX-
Lagoon # 17 6
Top Dike�c - O MG l Jy
Stop Pump ! ! �90�
Start Pump
Conversion- Cu -I 3000= 108 Iblac; Zn -I. 3000= 213 Iblar" 1r
C Oct -
cad s61) q$ co —

o vs 131 Mf )11311oy
Type of Visit QCCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
��/�
Date of Visit: Arrival Time: Departure Time: P County: Soh Region: •`�
Farm Nance: Hof t2'�10d� _ Owner Email:
Owner Name: Phone:
Mailing Address:nn Q&3
Physical Address:
Facility Contact: Na -k_ Aa- AUT Title: 0 W/l Pz— I PhoneNo1919,)68-87n
Onsite Representative: Integrator: M - L7
T
Certified Operator: V riff a k R*efyo+ _ Operator Certification Number: cPQSi6
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =4 = Longitude: =0
=
Design Current
❑ Yes
Design Current
sign Current
Swine C►opacity Population
Wet Poultry
,Cap qty Population' Cattle ' PEGa acity Population
u rrcaij w r1u15t1
M z _..__
!I s a c�
a. `.'.'as the conveyance Mari-inade?
M
1J Lnii �"uw
❑ N:
❑ Wean to Feeder
❑Non -La er
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Calf
Feeder to Finish
❑ NA
❑ NE
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ Farrow to Finish
La
❑ Layers
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ NE
El Beef Feeder
E] Boars
El Pullets
❑ NA
❑ Beef Brood Co
other than from a discharge?
❑ Turkeys
OtherE00ther
urke Poults
12/28/04
❑Other
Nutviber;of Strieetures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. `.'.'as the conveyance Mari-inade?
❑ Ycs
❑ N:
l�—I �i e
f 1 �tE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
U NA
ONE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NJ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JN No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

12. Crop type(s)
Facility Number. g — Date of Inspection >w-lalM
Waste Collection & Treatment
n��
13. Soil type(s) �(I 171�k 15 941415
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
© No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure v
Identifier:
❑ No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
Designed Freeboard (in): 19
❑ NE
17. Does the facility lack adequate acreage for land application?
Observed Freeboard (in):
FfNo
❑ NA
❑ NE
18. is inert a lack of properly operating waste application equipment?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(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
UrNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
N No ❑ NA ❑ NE
maintenance or improvement?
Waste AoPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CgNo ❑ 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)
n��
13. Soil type(s) �(I 171�k 15 941415
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�1 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?
MYes
FfNo
❑ NA
❑ NE
18. is inert a lack of properly operating waste application equipment?
Li Yes
lag No
u iv,y
u 114n
Reviewer/Inspector Name 5 � EjL I Phone.t�lf)
Reviewer/inspector Signature: Date:
Page 2 of 3 72/28/04
N
Continued

+I Facility Number: � a -5a Date of Inspection L+JJl11l�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N 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 J;jNo ❑ NA ❑ NE
I -I Uu. .. w . r. a t -I ut-6h, n'roati,..,..a ur.,...- A.,..i...., M c-:1 A. 1....... n Lxr-,+- r��. �r .�
u .. aw.., cJjFu�.auvu u ^.... y A Iwvv u u •• aa�c, r za.ja.a u u.,.. c�..a.ya.� u .. a.�.., uauo....� u r..auuoa ...........,.....,..
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " 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 Dd-NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
N No
[-INA
❑ 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
J�; No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
e*}�, SOLI taiys �r Oil+ �ab �Qr1e� IvOS' d Ori !rl o14p� ,
1vLTc� S l l dQe 61"-e 0y fhdU V`
)mdQ �ty , l "'t, In /Qa- y aa09.
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 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
RNo
❑ 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
9rNo
[--INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
U Yes
RNo
Lj NA
a NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ri!'No
❑ NA
❑ NE
s .
A�dclthonal omments an or Drawings:
I FPguado +opoii lienee eed�� rn✓r�, bae_ spoFs a, igsids
I�, p eon 'ioI rveedi a' sor ►�21aC�,
" Alf
1 _..� ,...�1VVj- y%'* n ok rr+- r -i-n. Ap rr, I14.0 r, Jm.�.�„
t�
e*}�, SOLI taiys �r Oil+ �ab �Qr1e� IvOS' d Ori !rl o14p� ,
1vLTc� S l l dQe 61"-e 0y fhdU V`
)mdQ �ty , l "'t, In /Qa- y aa09.
/ r
f lem e. Ca v k Gd cks I n t7b�
Page 3 of 3 12128104

• Facility No. 0-3) t Farm Name M& k p Date 11 1(f I Q g
Permit COC
Pop.Type Desi n Current
OIC
NPDES (Rainbreaker PLAT Annual Cert)
Sesign treeboard _------
Observed freeboaFd Sludg -Survev Date • -rm �Uqdid
Kul M�. Sludge Depth ft
Calibration Date
1 a5on 2 3 4 5 6 7 8
Design Flow
Rate inlhr Max Amt in:
Actual Flow
S
Design Width
307,
Actual Width
0
OP', lam
Soil Test Date i a Crop Yield 1 in Inspections
_� pH Fields 120 min Inspections ✓
Lime Needed I. Wettable Acres �� Weather Codes �-
Lime Applied a- ��"' .1To WUP `� Transfer Sheets rn GL
Cu ✓ Zn Weekly Freeboard 1_� RAIN GAUGE
Needs P p Rainfall >1"
Pull/Field Soil Crop RYE PAN Window
a
owvrsled OtS6
C As.
Verify PHONE NUMBERS and affiliations
Date_ last WI 1P FRO+I10{v Bata last WI IP at farm
OF FPO
Top Dike 58.0
Stop Pump
Start Pump 4� 3
OF-Fo0
AXHarriwaraMay
Rate inlhr Max Amt in:
N Amt 000 -
#
-
Pull/Field Soil Crop RYE PAN Window
a
owvrsled OtS6
C As.
Verify PHONE NUMBERS and affiliations
Date_ last WI 1P FRO+I10{v Bata last WI IP at farm
OF FPO
Top Dike 58.0
Stop Pump
Start Pump 4� 3
OF-Fo0
AXHarriwaraMay
Rate inlhr Max Amt in:
-
#-17+1 +9 -5 -two*
4of"I thele

Division of Water Quality
Facility Number�? a O Division of Soil and Water Conservation i .d /Qll
Q Other Agency 2� I �t 66
Type of Visit 9 Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Vit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ' d— Departure Time: County:
Farm Name: Owner Email:
Owner Name: ��— Phone: _
Mailing Address:
Physical Address:
Facility Contact:
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 Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region:
Phone o:
Integrator: _
Operator Certification Number -ft -0Q6
Back-up Certification Number:
Latitude: 0 0 = ❑ Longitude: =0 ='
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ec
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑
Turkey Poults
❑ Other
Dischames & Stream 1.., tits
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
[--]_Dairy Calf
❑ 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: ED
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
P NA
❑ NE
❑ Yes
❑ No ,UfA
EINE
❑ Yes
'@ No
❑ NA
❑ NE
[:]Yes
❑ No
�IA
EINE
12/28/04 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No [N NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0,No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes A 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? A Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;kNo ❑ 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 El Yes 19 El NA El NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�;No
❑ NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN � 1 Q0/ nr I n 1kc Fl T�t41 yPh`osphomc n �P.ilure t^v li »• �" •' �C7..0
_ t..,�,...0 `r . �.�aYv�ni�, irauiiLirG ��uug� ii�ty ua�c .]VJ!
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl
❑ Application Outside of Area
12.
Crop type(s)aps mxk& C obs
13.
.� n
Soil type(s) N t
14.
Do the receiving crops differ from those designated in the CAWW?
No
❑ NA El NE
15.
Does the receiving crop and/or land application site need improvement?
�,❑�Yes
( ([yds
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] yes
[VNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�KNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA EINE
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):
IS - N Md wXeN 4PT06(311
Q�^eAS �-,� f i r,s►� eIr
-
Reviewer/Inspector Name 14U11�T ME Phone: `A (, i
ReviewerAnspector Signature: _ � Elm&)
Date:
12/28/04 Continued

Ficility Number: Date of Inspection
Required Records & Documents .
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �Ao ❑ NA ❑ NE
20- Does the facility fail to have all components of the CAWMP readily available? If _Yes, check ❑ Yes 'FtNo F1 NA F-11 NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Annliratinn M we -k! Freeboard I__I'r/?..ate An 1l 4o I-1 C,^.,1 A."1 ;.� r-1 ; Imte 'trans em„ 1, A 1 Cert:ficat',.on
+ _ J V Ri]-� V u u ys `J u r+i�ia'u'aa
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes—VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
JYNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
[:]Yes
UNo
❑ NA
LINE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ko
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
4No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes .0 No
❑ NA
❑ NE
Additional Comments andLo�Drawings:"� _ y
AL
r i
'yt
Page 3 of 3 12/28/04

Facility No. �'�Z.� Time In X.15 Time Out D to `
Farm Name. Integrator
Owner Site Rep
Operator _o No.
Back-up U No,
COC Circle: General or NPDES
nt
Wean — Feed Farrow —Feed
Farrow — Finish
— F Gilts / Boars
Farrow — Wean Others
FREEBOARD: `Deign
Sludge Survey L/
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard tl Daily Rainfall Lf
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
D to Nitrogen (N)
Desiqn I Current
Observed
Calibration/GPM 71
Waste Transfers
Rain Breaker.
PLAT
1 -in Inspections ^�
Date Nitrogen (N)
Pull/Field I Soil Crop Pan Window
J V -
fl
4 rf 1
4

Type of Visit &Com Hance 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:0 a d p Arrival Time: Departure Time: County. Region:
Farm Name:yy_ Owner Email:
Owner Name: Q— 7 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: e-koi
Back-up Operator:
OL
ji'i Phone No:
Integrator: 'e rn
Operator Certification Number: ,5 ("
Back-up Certification Number:
Location of Farm: Latitude: =]o =' ="
Longitude: f --]O=' = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes &0 ❑ NA ❑ NE
❑ Yes
Design Currents
Design Current*=
Design Current
Swine
Capacity Population Wet Poultry
Capacity Pogulattoa Cattle
Capacity Population
lu wean to r imsn
I I
I' LJ La er1z
❑ Non -La er
E3(NA
LJ Dairy Crow
❑ Yes
❑ Wean to Feeder
❑ Yes
❑ Dairy Calf
❑ NA
ceder to Finish
zO
Dairy Heifer
❑ NA
❑ Farrow to Wean
Dry P nitry
t� ❑ Dry Cow
IJ � ai��w iv 1 ccucl
❑ La
x �,J 1V VLL-lldll
❑ Farrow to Finish
ers
❑ Beef Stocker
❑ Gilts
: ❑ Non -Layers
❑Beef Feeder
❑ Boars
L1 Pullets
El Turkeys
❑ Beef Brood Co
Other
❑ Turkey Poults
r.:
❑ Other
� Other
::.x
s Number of Structures:
NO
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes &0 ❑ NA ❑ NE
❑ Yes
❑ No
�ZNA
❑ NE
❑ Yes
❑ No
WA
❑ NE
E3(NA
❑ NE
❑ Yes
❑ No
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection a
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [❑ Yes [A.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,K -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly FreeboardWaste 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 "V No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
KNA
❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
Yes ❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
'Yes
❑ No
❑ NA
❑ NE
Sl U S v NeAj� &ne 'i m rr e c6t�-'e I
VYIU �-4 hcty e C�2 �.ib r Lcr. C!
-ca :a +e-,/4 &c e : d c de&rip
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
1%NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D(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
LN 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
33. Does facility require a follow-up visit by same agency?
)KYes
❑ No
❑ NA
❑ NE
Additional.Comments: and/orDrawings:1?
v s+ 1 , v,c c_ov,r� ln4 U_)Qs-�-e � ha f �s ; s
i C.4rn0%L^d, rr,o_trk� CaLznc�ar 4o sarn�1� ewnrn 3 n-ta,4s,
Sl U S v NeAj� &ne 'i m rr e c6t�-'e I
VYIU �-4 hcty e C�2 �.ib r Lcr. C!
-ca :a +e-,/4 &c e : d c de&rip
�,n I t, c Q- rr f toy'
P
RQ c omen c� � 6-J f con'-' / ' 6�: U._�a She. P t h .
— iJa� d C sx I 04'e t� LDO- �' +'� cO C ✓rYrt�t �y1
t>J `.��
Page 3 of 3 11/18/04

Facility Number. -6 -5a
Date of Inspection chi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate7
a_ if yes, is waste level into the structural freeboard?
,iiuciurc 1 St^ ctt re 2 St^actare 3 S ucture 4
Identifier:
❑ Yes JE�No El NA ❑ NE
❑ Yes ElNo .IRNA ❑ NE
ctructu-c 5 Structure 6
Spillway?:
t
Designed Freeboard (in):
Observed Freeboard (in): aZrj;
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Wo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes qNo [-INA [:1 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-! LJ Yes 2UNo LJ NA LJ Nt
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 [1aiNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes�'*o ❑ NA ❑ NE
maintenance/improvement?
I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,,DKj No ❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
rl PAN 11 PART �> IA01 nr 10 Ike I-1 T. til Ph—h—ve I—I Pn;1 rP t.. rnrr..-nnrotP AfonnrPlChlrloP intn RnrP Cnil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type
13. Soil type(
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes qNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?,Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes E[No ❑ NA ❑ NE
is there a lack of properly opc.mt.ng waste appi x;ativ±. 1-4 .1 P.LIis L—J i cs y(i'v V inn u -
Comments. (refer to question #): Explain any YES answers and/or: any recommendations or any other comments
Use drawings of facilit3 fo better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name����t. �� �V l r�� Phone:
Reviewer/Inspector Signature:
Page 2 of 3
Date: vL e— 7 6 -LA -A4
12/28/04 Continued

. . . �/ )I
Facility No. Time In Time Out Date - r
Farm Name integrator
Owner Site Rep
Operator
No.
Back-up No.
COC Circle: General- NPDES
Design Current
Design Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
-Feed - Finish- ,...L"
Gilts 1 Boars
-Farrow - can
Others
FREEBOARD: D sign
/Siudge Survey
Crop Yield
Rain Gauge
Soil Test PLAT
Wppklv Freehnard
Spray/Freeboard Drop
Weather Codes
Obsery
A�Iibration/GPM 1
Daily Rainfall
(
Waste TransfersN`` ff
Rain Breaker -
1'4 Wettable Acres
120 min Inspections
Waste Analysis:
Date Nitrogen (N).
z I6
1 -in Inspections1.t7
Date 1 Nitrogen (N)
3
Pull/Field Soil Crop Pan Window
t
r i .Q.

IType of Visit WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O'Aoutine O Complaint O Follow up O Emergency !Notification O Other ❑ Denied Access
I_0 Facility Number Date of Visit:Tune: 3: 3a
........��
Not erational 0 Below Threshold
LY-rermitted 0,6ertified 0 Conditionally Certified [j Registered Date Last Operated or Above Threshold:
Farm Name: ...... , !�'K art c `t— ---» County: So,n
OwnerName: ........ �....!�`-.._-.......... ........... ............................................. Phone No: ».� �._.... »...............�.....-._....... _.
Mailing Address: /bs� f''�,r? C F'`° 3 �T....
Facilitv Contact: ' fit .._--_.._-Title: PhoneNo:
fl- -#_ #e D.. Gnta"� ........... _.._..a.. _...
vaaa■ac 11p■AG■■au4te:. w...... � w»._._ ............._—._....._.......... 311 awr: ....�.-......_-_..._.�.._� ...........
....L—......" ' w...:.4:».:L1.[»............ acyl—J��._;; �=.L.........»....
Certefied Operator:.__»,....... . ��._ ...»_.�--- ..._____.... Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 44 Longitude 0 ` "
Discharises & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes aKo
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)
E] Yes ❑ No
c. If discharge is observed., what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [INo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [91go
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q i
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes E140,
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .. - - _ •.... .......----.-.-- . _...» .. _
Freeboard (inches):
12112103 Continued

i
Facility Number: y7. 1 Date of Inspection o q-
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate onblic health or environmental threat. notifv DWO)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
I0. Are there any buffers that need maintenancelimprovement?
❑ Yec M WK
❑ Yes ❑,ddb
❑ Yes EPNO
❑ Yes 2140
D Yes MoKo
❑ Yes [kio
a_ a...— __.:a____ _r--.__ ___n__.:__a rt_.__ _1__�..z_
■. ,� uicic LVIUL;LIUQ vi VVVL dFFL1Lauvi1: a ycb, Lucca uiv aj.rp,upraaM UVJL MIVw. 1J Yes L4,No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type .. ,. _ ecff- . fe-S,, -r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVW)? ❑ Yes [2f4o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 16 No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
I6. is there a lack of adequate waste application equipment?
Odor I%sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes []fio
❑ Yes [9,Ko
❑ Yes Q No
❑ Yes E14Qo
❑ Yes Leo
❑ Yes 0114o
❑ Yes M4o
❑ Yes M4 o
Commits (refer to quesfeon.#) Eiiam any YFS aresw s and/or st ey reeamrzrnda�ons or an othei�commrnts.'
w� _ —
T .—•- —� q
'Use,drawutgs of fart7ity to better tuaLoas. (a c ttan_al pages as necessary) Notes
eld Copy ❑ Final s
ka
4u� T- eo
H,
Reviewer/InspectorName _
Reviewer/Inspector Signature: Date: if23%0q-
12112103 Continued

i
Facility Number: 4ga Date of Inspection
Required Records & Documents
2I . Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Mill to .—I-sc lss re iiewlinspec4V11 wild 0011 -s -a- represcrtat;ve?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [90
❑ Yes EiWo
❑ Yes UKo
❑ Yes E?<o
❑ Yes [k<o
❑ Yes �o
❑ Yes �o
❑ Yes ,�'!4o
L'7
❑ Yes No
❑ Yes 814o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Q% No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtt10g81(iAfiitYteftt5"antl%r Ihawtng5
c Li- koxi &—a A _,.1 I
�
- �--• �..,v ��t�-.moi
12112/03

Site Requires Immediate Attention: _0
Facility No. 92 -,z
DIVISION OF ENMONIAENTAL MANAGEUENT
ANWI L FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: .1995
Time: '4 Lt::!,
—r n ��� t� u rn .1� L11Cifp
Farm NsmelOwner: � � v � � ►
Mailing Address: 1 �D 5 Q- ^ 1.e Q -Johnson Rid "� u r, n , (KI a 8 33y
County:
Integrator. 7D Phone: 50'� it -0,;z 15
On Site Representative: Do _C, MIC ynon j. _ Phone: X10
Physical Addressa ocation:
Type of Operation: Swine F+n Poultry 6ttic
Design Capacity: GWO xe . % &n _ Number of Animals on Site: �/30 -
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: N W * _j�L' 2U" Longitude: _2L' Q8_' Ji"
Circle Yes or No
Does the Animal Wastc Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)eUr No Actual Freeboard: __3 Ft ca_ Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes o No
Is adequate land available for spray?Gebr No is the cover crop adequazc? mac ]r No
Crop(s) being utilized:.�..s,
Docs the facility meet SCS minimum setback criteria? 240 Feet from Dwellings? ge-or No
104 Feet from Wells? QYVj r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applicd or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o 9
Is animal waste discharged into waters of the state by main -made ditch, flushing system, or other
similar man-made devices? Yes OG If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? r No
Additional Comments:
f l &--A £ � 1L) -
Inspector
Signature
cc: Facility Assessment Unit Use Artachments if Necded.

REGISTRATICN FORM FOR MIM -AL FEEDLOT OPERATIONS
Department of Environment, Health and. Natural Resources
Div_slon of Environmental Manac_ement _
Water Quality Section
i the animal waste manacement system
for vcur feed-oc operation
is
designed to serve more than or
ecua?, to 100 head
of cattle,
75
horses, 250 swine, 1,000 sheep,
cr 30,000 birds that
are served
by
a liquid waste system, ch en this
=1rm must be filled
our- and mailed
by December 31, 1993 pursuant to
?5A NCAC 24.0217(c)
in order to
be
deemed permitted by DEM. Please print clear?y.
Farm Name:
mailing Address:
County:
Owner(s) Name: G
Manager (s) Name:
Lessee Name:
Farm Location (Be
milepost, etc_):_
rection,
Latitude/Longitude ii known:„G(gS? 7f-_ 1.5--10-3 _�n2/ -OS- O
Design capacity of animal waste management syst m (Numb, and type
of confined animal(s)): W.Z 0
Average animal population on the fare (NUM er and type of animal (s)
raised) _ 2 0---�.e — -
Year Production Began:_ ASCS Tract No_: Z /�
r r -
Acres Available for Land Application of ste: ZI
Owner (s) Signature (s) DATE:-2f-4i7.-
DATE:
`S3.DATE:

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