820529_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: (DrCC Hance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral 0 Emergency Q Other 0 Denied Access 1
Date of Visit: t `Arrival Time: �i?cl Departure Time: ' S County: 5 ?1F1S� f! Region: (--in
Farm Name: ba -(J �S /u o. -S z'yy Owner Email:
Owner Name: _(Z p N a l t L, �Cc V S Phone:
Mailing Address:
Physical Address: le,
Facility Contact: C µ ��i r �3 A Lit`( r ( Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator- A)3 —s
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes D'No ❑ NA ❑ NE
❑ Yes
❑ No
E�NA
❑ NE
❑ Yes
❑ No
[Zj-?q-A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes D No C] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
2/4/2015 Continued

[Facility Number: Date of Inspection: ,Z, I A(sy
/
Waste Collection & Treatment
41s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g-llo­
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
[] No
D-1gA
❑ 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
[D. W
❑ 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
E:M6
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
D-5o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2-N-o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
2-IG
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑Yes 31fo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): —144 s it C)
13. Soil Type(s): o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [f No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records _& Documents
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 []'No ❑ NA ❑ NE
❑ Yes EJ-K—o ❑ NA ❑ NE
❑ Yes ❑_Piu ❑ NA ❑ NE
❑ Yes []-bia ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements F] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EINrr- ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El -Ko` ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3'o ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Z I Uate of Inspection: /may / r 1
24. -Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0'lq_o ❑ NA ❑ NE
0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E&N-5 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [[^No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C2,Ko ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes U>o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative.?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No ❑ NA ❑ NE
❑ Yes Lq1VO ❑ NA ❑ NE
[—]Yes 03 qo ❑ NA ❑ NE
❑ Yes Cj No
❑ Yes [2 -Na
❑ Yes [q'I`lo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signatur
Page 3 of 3
2/4/2015

0 -7 'S )"kms ! i ' l �.)( )
Z
(Type of Visit: Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: i2rRoutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Ar1rival Time: ` p Departure Time:I ,o /jF I County:[
Farm Name: ,jt7 Iv earl -V Owner Email:
Owner Name: oPhone:
Mailing Address:
Physical Address:
Region:
Facility Contact: OyAIT Title: Phone:
Onsite Representative: �C Integrator: KI r?`
Certified Operator: i� Q-C1�T _ Certification Number: Z F 7-13
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
r
ff&V} Design Current
j
Desi n Curr int ' I'
g� ,;
. Design Current
Swine Ca act
p ty p
Wet Poult p_ p
Cattle k, Capacity° Pop.
LLPo
YC_Po _�.
❑Yes�o
Wean to Finish
La er
Dai Cow
Wean to Feeder t pJ (00
Non -La er P
Dai Calf
Feeder to Finish
�ap-
Dai Heifer
Farrow to WeanDesign<Ciurren
Dry Cow
Farrow to Feeder
ll , 1Poultry :=,tCa�actPo�r
Non -Dairy
Farrow to Finish
La ers '.�
Beef Stocker
Gilts
Non -Layers -
Beef Feeder
Boars
Pullets
Beef Brood Cow
_=
Turke s
Other �A�, 1
Other
TurkeyPoults x
Other
Discharp_es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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
orthe State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No �A ❑ NE
❑ Yes ❑ No [;.NA ❑ NE
[:]Yes
0 No
�1A
❑ NE
❑ Yes
X10
aNA
❑ NE
❑Yes�o
❑NA
ONE
Page
Page 1 of 3 2/4/2015 Continued
-c-

Facili Number: 8X - Date of Inspection: ~�}
Wastd Collection & Treatment � ,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
i o DNA ❑NE
❑No [3<A ❑NE
Structure 5 Structure 6
❑ Yes kal�o ❑ NA ❑ NE
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 DWR
7. Do any of the structures need maintenance or improvement? [] Yes ❑-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes arNo ❑ 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 [ 01Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes ❑ol0 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes FEf'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): EGD
13. Soil Type(s): No
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [�o ❑ NA ONE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes [�No [:INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation desigm or wettable ❑ Yes ffNo ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes fNo ❑ NA ❑ NE
❑ Yes [r]'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes [f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E5N0 DNA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [j!r-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility umber: - Date of Inspection:
24. Dirt the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EjKo❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
KO ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[?'go ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E3"Ro ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ff"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
[30No ❑ 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
[;'fVo ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[:2No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E30�o ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E3"'No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No ❑ NA
❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of
facility to better explain situations (use additional pages as necessary). /
&((,(A 4f S -t-1-7
Reviewer/inspector Name: _ j
Reviewer/inspector Signature: 'Q3 i.
Page 3 of 3
q(0-3fpg-t61'5(
PhoneTo
Date:
2412 5

ins M MNl~
Type of Visit: U Cance Inspection V Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency Q Othere� Q Denied Access
Date of Visit: Arrival Time: Departure Time: X11 County: v Region:
Farm Name: 0w, t S Owner Email:
Owner Name: �t S Phone:
Mailing Address:
Physical Address:
Facility Contact: l..(� 4 Title: Phone:
Onsite Representative_ i Integrator: .413-5
Certified Operator: 2.? E�
Back-up Operator:
Location of Farm: Latitude:
Certification Number: Zyk,J
Certification Number:
Longitude:
Design @ut?ent
Design
Enrrent
1. Is any discharge observed from any part of the operation?
[-]Yes
Design Euvrent
❑ NA
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity I.
Wean to Finish
[]Yes
La er
'j NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
Dairy Cow
Wean to Feeder " 0l
E � NA
]Non -Layer
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
Daig Heifer
Farrow to Wean
❑ YesI
Design
Current
D Cow
Farrow to Feeder
" No
D , P,onit ,
Ca ac'
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
z
Turkeys
Other -, i�,
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance Haan -made?
[]Yes
❑ No
'j NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
E � NA
[] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesI
[jNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
" No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Date of Inspection: `
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [Z�jp NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No La4e ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�No
❑ NA
Designed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3<o
❑ NA
Observed Freeboard (in):y [►
acres determination?
❑ Yes
ffNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
18. is there a lack of properly operating waste application equipment?
❑ Yes
j(No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
E] Yes
E o
❑ NA
❑ NE
waste management or closure plan?
❑ 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 improvetrtent?❑Yes
aeo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�J<
❑ 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
;""
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
to
❑ NA
❑ NE
maintenance or im rovement?
p
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 10 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): .0 e4k.+ 'E Co -0
13. Soil Type(s): O
❑ Yes
❑✓ �No
❑ NA
❑ 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 facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3<o
❑ NA
❑ NE
acres determination?
❑ Yes
ffNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
t No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
j(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 p Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ffNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L2r�4o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNo
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: WX - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V?Ko' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [B<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes W<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 12 <0 ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes U�rVo ❑ NA ❑ NE
❑ Yes Er<o ❑ NA ❑ NE
❑ Yes ]o [:]NA E]NE
❑ Yes Wx"'o
C3 NA E] NE
❑ Yes ❑ NA ❑ NE
Phone: 133'--333f
Date: 10A
21412011

Koutine Q Complaint O Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time:I yfj(2 off Departure Time: County, —FA= Region: aD
Farm Name: Q v Cr Owner Email:
Owner Name: r'1 JCGV T Phone:
Mailing Address:
Physical Address:
Facility Contact: C t, t&4-( i 6 -41 k(41<_ Title: Phone:
Onsite Representative: 1( Integrator: r" 9
Certified Operator:lz �j i7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 94,XZ,3
Certification Number:
Longitude:
(�0
Feeder to Finish
Farrow to Finish
Gilts
Discharges and Stream impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure E] Application Field ❑Other:
NA ❑ NE
a_ Was the conveyance man-made? ❑Yes ❑ No � ❑ NE
b_ Did the discharge reach waters of the State? (if yes, notify DWQ) ❑Yes ❑ No ❑`3Q1C ❑ 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 ❑ NI:
2. Is there evidence of a past discharge from any part of the operation? E] Yes Q"�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes �o ❑ NA ❑ NE
of the State other than fr
❑ Yes Ejb�
om a discharge?
Page ! of 3 2/4/2011 Continued
Type of Visit: PQ,6m Bance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q
Design Current
* y,x Design) Currents*40
y Design Current
Swine
Ca aci Po
iWet�Poult . Ca aci Pot)
tY� P
CattEe� Ca aci Pv _
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
0
" Nan -La er
Dai Calf
Dai Heifer
Farrow to Wean
Design Current'
D Cow
Farrow to Feeder
�D P ul Ca aci - PoP.
r
Non -Dairy
Layers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys r
Other
- TurkeyPoults
Other
--P.•.:,i
Other
:. r_:.Y..61a:...m�u.,. . . -
CCS.
(�0
Feeder to Finish
Farrow to Finish
Gilts
Discharges and Stream impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure E] Application Field ❑Other:
NA ❑ NE
a_ Was the conveyance man-made? ❑Yes ❑ No � ❑ NE
b_ Did the discharge reach waters of the State? (if yes, notify DWQ) ❑Yes ❑ No ❑`3Q1C ❑ 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 ❑ NI:
2. Is there evidence of a past discharge from any part of the operation? E] Yes Q"�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes �o ❑ NA ❑ NE
of the State other than fr
❑ Yes Ejb�
om a discharge?
Page ! of 3 2/4/2011 Continued
Type of Visit: PQ,6m Bance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q

Facill Number: - Date of In sp ection:
C) yhm-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3 KA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Yes
Identifier:
❑ NE
❑ Yes
[2_o— ❑ NA
Spillway?:
Designed Freeboard (in):
❑.-N►i6— ❑ NA
❑ NE
❑ Yes
Observed Freeboard (in):
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2] -Fe--❑ 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
[�]�o ❑ 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ie ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E:[ -Ne ❑ 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 p❑ Evidence of Wind / Drift ❑ Application Outside of Approved Area
SC7
12. Crop Type(s): �� PfV�t f�( vCr� a cy L) -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[,S ❑ NA
❑ NE
❑ Yes
D#o ❑ NA
❑ NE
❑ Yes
[2_o— ❑ NA
❑ NE
❑ Yes
❑.-N►i6— ❑ NA
❑ NE
❑ Yes
E]' -9_o❑ NA
❑ NE
❑ Yes N
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [ No
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L ' o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []["'No
E] NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: APL - Date of Inspection: f7 51
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [cg -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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.
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EEJ`No ❑ NA ❑ NE
[-]Yes []�I�o ❑ NA ❑ NE
❑ Yes [g -NV- ❑ NA [] NE
❑Yes [�❑NA E] NE
❑ Yes E] "o [DNA ❑ NE
❑ Yes D A" _o ❑ NA ❑ NE
❑ Yes
®'o
❑ Yes
0"N-0
[:]Yes
�o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: �f` ✓
Page 3 of 3 1✓4 UI4

Type of Visit: &C6mpliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (DAG"utine 0 Complaint 0 Follow-up a Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: Countyz�'l Region
Farm Name: Owner Email:
Owner Name: P-OtA- a1( L Phone:
Mailing Address:
Physical Address:
Facility Contact: ca{f I S I (,if/"Title: _�e t%V Phone:
Onsite Representative: (� _ integrator: pie
e
Certified Operator: P_t30'"Ic Certification Number::
Back-up Operator: 4� Certification Numbew`fJ ol_&
Location of Farm:
Latitude:
Longitude:
esi�n, Current
pa�crtl°�' Pop.
.`E+D� n Current
,
NOT
Poultry '� C�apac�tyPop - -
Design Current
Cattle Capacity PoP-
❑ NE
Wean to Finish
Layer
Dai Cow
❑ NE
Wean to Feeder QQ r li-
Non -La er
Da' Calf
Feeder to Finish
*�`� �' 4'� � �
Da' Heifer
Farrow to Wean
Farrow to Feeder
'Des g �urrent
DPault Ca acs Po
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- Turkeys
Other x
Other
Turkey Poults
Other
Discharges and Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes ~❑ NA ❑ NE
❑ Yes
❑ No
❑ NE
[:]Yes
❑ No
[;IN -9
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No CJXA ❑ NE
I.
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [�t o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ❑VNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3
N
2/4/2011 Continued

Faeility Number: - Date of Inspection:
Waste
ns ection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C�Jo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [14 -UA.- ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D -Na-- ❑ 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
❑..iia---❑ NA
❑ NE
waste management or closure plan?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E440o-'
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
❑-Ko [] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q..N� ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[-No' ❑ NA
❑ NE
maintenance or improvement?
F3 No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
QNa [] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [3'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 Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6-eL 4Z C7 D _ A4
13. Soil Type(s): fV b t1. kv-k tl
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
URI<
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E440o-'
E] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes
❑ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
13<0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Flo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists p Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [�o DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Mombly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 12� [:] NA [:] NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ;Z [j NA [] NE
Page 2 of 3 2/412011 Cmidnued

Facility Number: 7C- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-G-0 NA ❑ NE
2b. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []. hr- D NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [R<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑<o ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerllnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
No
E�N
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
NeArawinzs
mments (refer to:question ft Explain any YES answers and/or any additional recommendations or any other.commentsm
of facility to better explain situations (use additional pages as necessary).'. r
WlbVN4('--
(uj 5;e- 5_� I �' - 1 0 14 t q P Lf
- �_o h 1
Reviewer/Inspector Name:
M
Reviewer/Inspector Signature: Date:
Page 3 of 3
I

type of visit: Ly-compttance inspection t1 uperatton xevtew a structure tvatuaaon V t ecnntcai Assistance
Reason for Visit: Qoftoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: {� j a Arrival Time: d f}M Departure Time: U7.��S County: T
Farm Name: Qz)Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �-Of<VYS a"kUysc- Title: Phone:
Onsite Representative: ,Sg
Certified Operator: [N0r'P "h nQ,xn-_S
Back-up Operator:
Location of Farm:
Latitude:
Region: rAr
Integrator: IhURDh,t 'i�R llj
Certification Number:
Certification Number:
Longitude:
Discharges and- Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �No ❑ NA ❑ NE
❑ Yes [:]No ff NA ❑ NE
h. Did the discharge reach waters of the State? (if yes, notify DWQ)
Cu
[:]No
& A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Design rentIN
Design
Current
Design Current
Swine
Capacity t op
�,
Wet Poultry
Capacity
Pop.
C+attEe Capacity Pop.
Wean to Finish
❑ NE
La er
❑ Yes
dNo
Dairy Cow
Wean to FeederO
aU ►a5O
Non-Laer
Dai Calf
Feeder to Finish
�-
_
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
„ pr^ �Psoult .
Ca achy
Pio ..
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
OOtber
Turkey Poults
Other
Other
Discharges and- Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �No ❑ NA ❑ NE
❑ Yes [:]No ff NA ❑ NE
h. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[:]No
& A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[D'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dNo
❑ NA
0 NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: a Date of Inspection: 5 a h
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�]4 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [g"NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: $1 :1 --
Spillway?:
Designed Freeboard (in): 14
Observed Freeboard (in): a5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F;;�o ❑ NA D 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 [Ef No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E' No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑'Yes [:]No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [N/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[] Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type{s}: OffqMufA S-6,0
13. Soil Type(s): /i%U
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ffNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes [TNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [g No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [DNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No [!�NA ❑ NE
Page 2 of 3 2/4/2011 Continued

5)h2/1 a
�Faeilitr Number: R a - Sa cl Date of Inspection: - 4gt;Fg4V
24.
ns ection:-
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes C� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CD No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E .Ao ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [::]No [JXA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at,the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes CD No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes []'No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [2 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E!�No ❑ NA ❑ NE
Reviewer/inspector Signature:
Page 3 of 3
Date:
2/412011

Spa. v . aaaa. p a..vaaIPUnU�e auoYca,aaaeu y WPWI QESEEu MCTMn V "CE ua.auaa. a,:ra1aaa61W5J t,/ ■ VVIRREmAX ­aaaawu
Reason for Visit: +9'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: (14.Lr_�LS L Title: Phone:
Onsite Representative: tp Integrator. % 6
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Des�gnCurrent
ka,^t yDesgn went
Design Current
❑ NE
'
❑ No
ity Pap.
❑ NE
❑ Yes
1 o
❑ NA
❑ NE
Finish
rPFeeder
Laver
Dai Cow
Feeder
Non La cr
Dai Calf
o FinishDairy
zf�
Heifer
Farrow to Wean
Design Gurrent,
jDry Cow
Farrow to Feeder D Poul! w Ea act P,.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Lavers
Beef Feeder
Boars
Pullets
LBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream lmnacts
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 wafers 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?
❑ Ycs Lam"° ❑ NA ❑ NE
0 Yes
❑ No
[g KA
❑ NE
0 Yes
❑ No
Ea -<A
❑ NE
❑Yes
❑No
[pa
❑NE
❑ Yes
[P -<o
❑ NA
❑ NE
❑ Yes
1 o
❑ NA
❑ NE
Page 1 of 3 21417011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No O� A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
Spillway?:
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E<
❑ NA
Designed Freeboard (in): -
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
['No
❑ NA
Observed Freeboard (in):
the appropriate box.
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
�,�
IAVo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
'
GkKo
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
L J46"
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4$ 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
& Do any of the structwes lack adequate markers as required by the permit?
❑ Yes
1_1,11'
❑ 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
es
Q No
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LJ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
iJ o
❑ NA
❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): " . I- (
13. Soil Type(s): ALk 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yeso
[DNA
E] NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
!
E3- o
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
Io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
524x'
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E<
❑ 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
'
GkKo
❑ NA
❑ NE
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes to ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑No 52 -KA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [r'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes &<o ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[] Yes
1Jd" o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
❑ No
❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
��''
n
❑ 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
®,Ko'
❑ 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
LJ -11O
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[9-
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R'No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
EKO
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Eg-T o
❑ NA ❑ NE
-Pj,e -5e, i � t4t� GAS t kid-tc4ed 11
1 t3 t k r&,
r �
l
CV -5 A/45
Reviewer/Inspector Name:
Reviewer/Inspector Si
Paige 3 of 3
Phone:
Date: T,
l/4 4II

B17M< 2-04- Znln
C
- ivision of Water Quality
Fact�lity Ne><mberZ '� $Z Division of Soil and Water Conservation
Q Qthcr Agency
Type of VisitC3'G"ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit c3t�toutine 0 Cornplaint 0 Follow up 0 Referral O Emergency. 0 Other ❑ Denied Access
Date of Visit: 2-03 -/p Arrival Time: Departure Time: County: -sa`^ Region:
Farm Name: Ro-/a/d Uetv,`s 4447c� Owner Email:
Owner Name: —!'0 AI Lld b&Vg's Phone:
Mailing Address:
Physical Address:
Facility Contact: /7`s Title: s �. Phone No:
Onsite Representative: Integrator:
Certified Operator: %20 Na /d/ ZY • Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 =I=" Longitude: =0=1 = u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C•attic Capacity Population
❑ Wan to Finish
❑ Layer
❑ Dai a Cow
a. Was the conveyance man-made?
B"Wean to Feeder 1/2470 O
❑ Non -Layer
❑ DaiEy Calf
❑ NE
❑ Feeder to Finish
❑ Yes
❑ Dai Heifer
❑ Farrow to Wean
D , Pault .
!'ylE-_ r?
❑Dry Cow
El Farrow to Feeder.
- '' ""
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑-, Ngo
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cori
.._
❑Turke s
❑ Yes
No
Other
❑ Turkey Poults
other than from a discharge?
❑ Otho
❑ Other
11 liz 1111
Number of Structures:
11128104
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C� o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
[I Yes
❑ No
,�,/
LINA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
3'1GA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑-, Ngo
,�/
L] iNA
[1NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
D o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
11128104
Continued

ar '
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2<01 ❑ NA ❑ NE
❑ Yes [TIO ❑ NA ❑ NE
If any ofquestions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes BNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?❑Yes No [__1 NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ErN
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes &No ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 0 ❑ 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) Jkw olr4 L/ ,
13. Soil type(s) a A �,,� _
14. Do the receiving crops differ from those designated in the CAWMP? El Yes U ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application`? ❑ Yes
1$_ is there a lack of properly operating waste application equipment? ❑ Yes
tom [:1 NA ❑ NE
a oo ❑ NA ❑ NE
Ek<o ❑ NA ❑ NE
9 o [j NA El NE
Comments (refer�to question #):. Explain any YES:answers and/or, any recommendations or anv oth r comments
Use drawings of fac�Iity to better explain situations {nse additiouat pages as necessary} x
/V -A, GU f [3U4 -e-✓ 5 lopes o n3 i�al�G 5:'a/� d f
L4�6ar�
Reviewer/Inspector Name��` I��.✓.,5 :4 '?' .''' __ Phone: 91b� x'33.3300
Reviewer/Inspector Signature:
Date: 2 — 03 -20 /0
12/29104 Continued

f `
Facility Number: 82 ;$Z9 Date of Inspectiou 2-03—/O
Reguired Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (B o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ERIVo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections [I Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L7lgo
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElB Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ngo
❑ NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,[9
0
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Bko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Eg<o
❑ NA
❑ NE
Other issues .�,,/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElC
Yes Cg<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
G'Iqo--
❑ 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
��,��
E o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�
B o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
��--,,��
L`SNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IJ'No
❑ NA
❑ NE
12128104

tvision of Water Quality
111 Facility Number 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit (D-CoGpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `!x-23 -G �} Arrival Time: /.' YO Departure Time: ; Qr County: Region: 1�� -
Farm Name: !/Ll V % c) ►'S�-� Owner Email:
Owner Name: lUK V S Phone: _
Mailing Address:
Physical Address: //33
Facility Contact: C (4 041.5 ZS4r W i.0 K Title: Phone No:
Onsite Representative: Integrator: C kixVi e-
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: El o E__1 w Longitude: = ° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
131vean to Feeder imoo ❑ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
ff Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ETurkePoults
jOther
Discharges & Stream I. mnacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �I
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
G� ❑ NF
❑ Yes
❑ No
LS ivA
❑ NE
D-<
❑ NE
❑ Yes
❑ No
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
31vo ❑ NA
❑ NE
12/28/04 Continued

Facility Number:82 "SZy Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ,Q,�o�❑ NA ❑ NE
❑ Yes LSI bio ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?: /10 r,V cl.f+_
Designed Freeboard (in):
Observed Freeboard (in): -540 s*'
U5. 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
Ef No ❑ NA ❑ NE
through a waste management or closure plan?
t, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo.
7. Do any of the structures need maintenance or improvement? 1:1 Yes❑
NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes
No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No [INA ❑ NE
mai ntenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2No ❑ 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 El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) ,iJJe f -M v,cl cL (flay � �/�ttti !� C f -M N LO, S.)
_
13. Soil types) �b
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
El NA [:1 NE
15. Does the receiving crop and/or land application site need improvement? ElE,
Yes
�NNo
/
Nc ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No ❑ NA EINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
5 o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0to ❑ NA ❑ NE
A0 111011
4o bcAle n.t ard.kra,cr `
i..;/I NI - C3 Q/'o IV-7a/1a11�-L/o iNS?'C-f' b�7' "k -
Dc C'.e i --6 -✓ '31 3 -Z c Oct • S r e.— 4c G�f i I - Lt a al c wn1
-4- +o e- o�f !a v�n1 Stn s R
Reviewer/Inspector Name I ii Re- veS Phone: 13-7;
z� .rl',c Date: 7 g
Reviewer/Inspector Signature: moi- — � --Loo
Page 2 of 3 12/28/04 Continued

r. y:72 oC
Facility Number: YZ 57-9 Date of inspection
Reauired Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes & No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes AYU ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lldo ❑ 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 L7No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes B o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes,L.,, No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes L:T<og�❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L'TNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑Yes
o
[:1 NA
0 N
E] Yes
,L�T,N
t.l,,iq/
[:1 NA
[:1 NE
❑ Yes
0<0
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
0-14o
❑ NA
❑ NE
I2r2&04

I
'F.Zst-I Y 9 —O el - 0 8 22
Type of Visit C3-e6mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: / wee Departure Time: 2:05 s� County:. -5 2:e50A✓
r
Farm Name: 1�ri U 1's k!'Se� - Owner Email:
Owner Name: RoN4 I d _ Phone:
Mailing Address:
Region: /4'ea
Physical Address:
Facility Contact: Ci//��
rc #-fA S RG✓kh Title
SP�-� Phone No:
Onsite Representative: Cil/firsal�-+' Gl'�"-- Integrator: (6
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: E o = Longitude: =0 = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
.ZOt7 �.JZ ❑ Non -Layer
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cti
Cattle Capacity Popii
J Dairy Calf
]
Dairy Heifer
]
Dry Cow
]
Non -Dairy
] Beef Stocker
] Beef Feeder
] Beef Brood Cow
Number of Structures C
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 EH16- ❑ NA ❑ NE
❑ Yes
❑ No
[, NS�A
❑ NE
❑ Yes
El No
EWA
❑ NE
21 A
❑ NE
❑ Yes
No
❑ Yes
�❑
vog
U r
❑ NA
❑ NE
❑ Yes
B<
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 044=0 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/ El Evidence of Wind Drift ❑ Application OutsideofArea
12. Crop type(s) . Re' ✓Ki u ck, l6ra3 'r- n/ eleg. S. J
I3. Soil type(s) /A/'0 /4 -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LK ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes O✓Na [:INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes E3 -Ko ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? [:]Yes 0*cj" ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ ?4T ❑ NA ❑ NE
Reviewer/Inspector Name I Kt -L L'e-Ve.I S Phone: 410.5x3.3. 3330
Reviewer/Inspector �,�,a-� Date: 8- Z/ J ZU��
Page 2 of 3 12128/04 Continued
Facility Number. Date of Inspection 8 -2 (—O g
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
9< ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z7 �1 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9 -Ko' ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
0~To— ❑ 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
01To_ ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes
O -Ko- [INA
❑ 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
Q1' iu- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B175-_ [:1 NA
❑ NE
maintenance/improvement?
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 044=0 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/ El Evidence of Wind Drift ❑ Application OutsideofArea
12. Crop type(s) . Re' ✓Ki u ck, l6ra3 'r- n/ eleg. S. J
I3. Soil type(s) /A/'0 /4 -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LK ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes O✓Na [:INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes E3 -Ko ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? [:]Yes 0*cj" ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ ?4T ❑ NA ❑ NE
Reviewer/Inspector Name I Kt -L L'e-Ve.I S Phone: 410.5x3.3. 3330
Reviewer/Inspector �,�,a-� Date: 8- Z/ J ZU��
Page 2 of 3 12128/04 Continued

I
Facility Number; '3Z —$2` pate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [31fFo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B<o ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design g ❑ Maps p ❑Other
21. Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes ❑'To- ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[9 -No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
QNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Eal o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3'1 iso
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[j1q`J
❑ 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
[3`5o
❑ 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
l -J Ro
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
][,No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
8 rvoNo
❑ NA
❑ NE
Page 3 of 3 12/28/04

® Division of water Quality /
111 Facility Number gZ S29 0 Division of Soil and Water Conservation11 01
Q Other Agency
(Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit ®Routine 0 Complaint O Follow up O Referral o Emergency Q Other ❑ Denied Access
Date of Visit: /0-0/-67 Arrival Time: 7; CO Departure Time: Z: 3i County:
Farm Name: Ila q FQ i., .... Owner Email:
Owner Name: -��� _ 1+�/D A/ =•b S /V"�S�'� Phone:
Mailing Address:
Region: Azo
Physical Address:
Facility Contact: Cw-gi s RCy W, J[ Title: —5Nt/. /lfSl-• Phone No:
Onsite Representative: Cu"'F`S 3an..wiIntegrator:. CAk0.✓tL F'ray-t
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o F --T F Longitude: C
Swine
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
—200 ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
E]Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
EINE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[ No
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

e �
Facility Number: SZ L Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
..
Observed Freeboard (in): ,;1 19r -70
5. Are there any immediate threats to the integrity of any of the structures observed?Yes �7j 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 [XNo ❑ 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 [P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require JfYes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes MNo ElNA ElNE
11. Is there evidence of incorrect application? If yes, cheek the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s) W uaf �t �'''s �� i+we i< r9 M. N (0
13. Soil type(s) p A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes , A No ❑ NA [INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes Irl No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facilityI
to better explain situations. (use additional pages as necessary):
Reviewer/Inspector ]dame I ICK CVC i S
ReviewerAnspector Signature: KtA wej'
Phone: Q10, q33.330
Date: /O - 0/ - Low
12129104 Continued

- - •
Facility Number: $Z -SZ9 Date of Inspection 1/47-0 /-071
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E6 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [UNo ❑ 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
[!jNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[21 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(B No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q'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
GINo
❑ 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
[XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q1 No
❑ NA
❑ NE
Additional Comments and/or Drawings:"'
12/28/04
12/28/04

Type of Visit (compliance Inspection U Operation Review Q Structure Evaluation ,TUU Technical Assistance
p
Reason for Visit O Routine Q Complaint 0 Follow up 0 Referral Q Emergency other ❑ Denied Access
Olt��_ ��
Date of Visit: r!LJ Arrival Time: Departure Time: County' Region:
Farm Name: �nL+ . k i ria fcr ra"_ � Owner Email:
{_r
Owner Name: dgay- u ; Phone:
Mailing Address:
Physical Address:
Facility Contact: +66e Title: Phone No:
Onsite Representative: Integrator: 't2fu4 a k1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e [� I [� it Longitude: ❑ 11 ❑ I ❑
Design Gurrent
Design Current
Design Current
Swine Capacity PopWation
Wet Pouttry Cap�acciity PapWatiou
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ NA
❑Dai Cow
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Wean to Feeder I I❑Non-La
et
❑ Da' Gaff
a. Was the conveyance man-made?
Feeder to Finish I 40 -DO I
❑ No
❑ Dai Heifer
❑ NE
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ NA
❑ Farrow to Feeder
c_ What is the estimated volume that reached waters of the State (gallons)?
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
C3Beef Stocket
❑ Yes
El Ga
❑ Non-ts era
❑ Beef Feeder
2. Is there evidence of a past discharge from any part of the operation?
❑ Boars
❑Pulle
❑ Beef Brood Co
10 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turkeys
❑ No
Other
❑ Other
❑ Turkey Poults
Number of Structures:
ther
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
a o
❑ NA
HNE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
10 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
Q NE
other than from a discharge?
IZ-28104
Continued

Facility Number: — p? 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
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 19 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 g,No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?❑Yes �No
❑ NA WNE
(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 Wo
❑ NA 91 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA 0 NE
maintenance/improvement?
11. Is there evidence of incorrect application? I f yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA PZ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No
❑ NA R NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No
❑ NA [2 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No
❑ NA N& NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
❑ NA KNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No
❑ NA JZ1 NE
Comments (refer to question #}: Explain any YES;answers and/or any recommendations or any,"60f6 x_
Use drawings of facility to better explain situations. (use additional pages as necessary):
,
7Y3-.L/! ��t�""LG S a S S r te'"' �k5P T/Jr• A,4-4, 74�J/�°4
p`t � n.. �S1itaWin� `.o07'XITin.
+.
T
Reviewer/Inspector Name Phone: /Q 3Q ty
Reviewer/Inspector Signature: Date: — {p
Page 2 of 3 12/28/04
Continued

I�
Facility Number: $' Date of Inspection 6 -
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ❑ No ❑ NA K NE
❑ Yes ❑ No [INA Q NF
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[] No
❑ NA
9 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?
N Yes
O `Vo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
(ONE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
M NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
(Q NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
(XI NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA WfNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[3 yes
❑ No
❑ NA
03 NE
and report the mortality rates that were -higher than normal?
H
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
Q NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
(A NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
)} No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;@ No
❑ NA
❑ NE
Additional Comments and/or Drawings: n �, ,"�,�41 � "�?•:
PX QVVL
H
Page 3 of 3 12/28/04

®Division of Water Quality
Facility Number SZJ SZcJ ODivision ofSoil and Water Conservation y
0 Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S 03 -Oh Arrival Time: 2:4 S"" Departure Time: County:
Farm Name: C IruwAl rOwner Email: /
Owner Name: ICgi--r.,�r�. �.-� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:-var+i S Imo. i e. V_ Integrator: Cc "C' L.
Region: 1 i O
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o =I =,1 Longitude: =o =
Swine
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
900 1 885 1 ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharacs & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Coy
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ='',
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
[9 No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: SZ — 5721 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 -
Spillway?:
Designed Freeboard (in): I q l9
R
Observed Freeboard (in): .32..
❑ Yes [29 No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [)[ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
No
❑ NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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. Croptype(s) 01cv.,,..&AC_ - C�-, � — 0jF_V�tcaL
13. Soil type(s) A10 ricc I L,/-
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
{j No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations
❑ Yes
01 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
ezplaWcsvt aEions:f(i
Reviewer/inspector Name /L;cX AGPhone:
Reviewerlinspector Signature: tl� Date: S —C — Zc'O 4i
12/28/04 Continued

Facility Number: SZ -5Z Date of Inspection TO__T D
Required, Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(,V No
❑ NA
EINE
27"
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JXI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JZ No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additzorial'C6mments.and/orDrawings '
12/28/04

U
8.2 H sa,7
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 ' -4 Arrival Time: 3. Departure 'time: County: -5W.,o9son Region: Fp
Farm Name: _. Co%ce -allldc F6c^01Owner Email:
Owner Name: 2ajY.�f Phone:
Mailing Address: 3 fYO TIg La., e _.,. _ Cf'i� r'on ti� 283 2 J?
Physical Address:
Facility Contact: 60, /;, Q & Title:
Onsite Representative: Cor jqScc,,«�.y(!,fec4
Certified Operator: Sv,. Meds
Back-up Operator:
Location of Farm:
Phone No.
Integrator: _Co & c
Operator Certification Number: 73a
Back-up Certification Number:
Latitude: F70 [= 1 0« Longitude: =0=1 o=1
Design Current Design ' Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
,Wean to Feeder a ❑ Non -La et
3
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
0 -tilts 40 O
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
.Design Curren
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stoeket
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
r
❑ Yes 2f,�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
Yes
[I ❑No
❑ Yes
E'No
❑ NA
EINE
❑ Yes
2�Io
❑ NA
❑ NE
12128104 Continued

Facility Number: — 5
Waste Collection & Treatment
Date of Inspection - of
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: " 4
Spillway?: n D
Designed Freeboard (in): I y
Observed Freeboard (in): _ _ 31
a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 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 g 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? [xYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EMo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑'&o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DriA ❑ Application Outside of Area
EGD ,r0
12. Crop type(s) 64CM uc%a &Ia/l
13. Soil type(s) 1✓p r or,/
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LSO" ❑ NA []'IQE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes ❑ No ❑ NA [2 E
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
`l PI[GSG {�x ffi[ -2 ltoltJ 0A 'AAe &*d -6,A
❑ Yes E3 No ElNA EIKE
[IB Yes o ❑ NA ❑ NE
W Art la ea.) k,1e4 /I
Reviewer/inspectorNameAO / f/ _ Phone: �U�y -I' A s.,
,a.� � amu... r_y
Reviewer/Inspector Signature: lft4Date: a-0"' 3 /f! •U 5-
12/28/04 Contenued

Facility Number: � �'3q Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ['fes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 21g10 ❑ NA ❑ NE
the appropirate box. ❑ WOr ❑ C fists ❑ De<g­n ❑Imp§ ❑ O>et'r
21. Does record keeping need improvement? If yes, check the a propriate box below. Gj"res ❑ No ElNA ❑ NE
E ante Application ❑ Weelcly-freel3oard ❑ ase rrmsfers ❑ -on
❑ Rairrfali C31,Aarkmg ❑ 6rep-Y:ie}d [120 Minute Inspections❑ 9 -Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Eg o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
271E
❑ Yes
❑ No
❑ NA
O'RE
❑ Yes
❑ No
ElNA
2KE
❑ Yes
M-1Vog
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
E?I E
❑ Yes 9lo ❑ NA ❑ NE
❑ Yes DIVO ❑ NA ❑ NE
El Yes !� No [:1 NA
El NE
❑ Yes a'No ❑ NA ❑ NE
❑ Yes 014o ❑ NA ❑ NE
❑ Yes 21�o ❑ NA ❑ NE
IM8/04
Iy Thr Aepw pe. -,,,'7' ,.% A;, 0, �
a+e/s, .�i7,�p �c /far G✓ • �� MCi. � L
R e�p�,
I
& r^ / Q
f �� �!� r,carY Cou�id9 C /%.J. op/4ee w�li5 /7ari.� rLc�,t,�
f
10leosa (-t[ newfar+, with tec& '„
IM8/04

Type of Visit O'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number .1 Date of Visit: ® Tune: 3'. i70
Q Not Operational O Below Threshold
ff f ermitted ErCert(iified [] Conditionally Certified 17 Registered Date Last Operated or Above Threshold: ------- --
Farm Name: " ..r .. R Countv:......_.......
r u.- -- ------------- � m_ _ _
Owner Name:..... 1, "� .. �Yticw.piG k Phone No: g./0 w 4 a " 1r�
MadingAddress: 1 11...�----... .. __ .Ne-_.
Facilitv Contact:G ...... _-- Title >+tQ Phone No:
Onsite Representative: •__•�_±� -L�' S &—Wi cK Integrator:
Certified O rator ... . Atcvt5_ _. .......... ....._.. Operator Certification Number:
Location of Farm:
A.I
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� �4& Longitude • 9 49
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes BNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [a'go
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ErNo
Structurc I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...........!.............. a ........ ....•
Frecboard (inches):
12112103 Continue .

Facility dumber: �,Q — S�Aq Date of Inspection S o 0
5.'Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
214o
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
❑ Yes
[vrio
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
[EfNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
(2 -kc,
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
[j'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
[�No
11. Is there evidence of over application? If yes, check the appropriate box below.
[] Yes
YNo
❑ Excessive Ponding [I PAN ❑ Hydraulic Overload [3 Frozen Ground ❑ Copper and/or Zinc
12. Crop type Dom' Z "JI fA;14 oyfr6c4i
13. Do the receiving crops differ Jth those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[rio
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
M+ No
b) Does the facility need a wettable acre determination?
❑ Yes
E(No
c) This facility is pended for a wettable acre determination?
❑ Yes
[fNo
15. Does the receiving crop need improvement?
❑ Yes
Q'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[+(No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes [rj"No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [rNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes 2No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ["No
Air Quality representative immediately.
CommeaLs {ref
�er to question } Ezpfaus airy YFS ans vers sndfor amy_rec�m�iendaktosas ar.aay tlur comments.
4: v- - �.....'.'c-�.��"..�---"'- ems••:= --x _ � - - _�
;Use riiawtugs of fac�7ity to better expldun sttaahwus. (use addrtxanal pages as aeces�ry) �, [��eld COPY ❑ Fnral Notes � ` =�'".
k5 4. C"al
T
Reviewer/Inspector Name Kx 4
.,� F:f,
.oq- e
Reviewer/Inspector Signature: Date: S/.2 a
12/12/03 V Continued

FaeilitNNumber: gA - 29 Date of Impecdon ;b o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ 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 Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWIvIP?
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 l " Rain
❑ 124 Minute Inspections ❑ Annual Certification Form
❑ Yes f 2rNo
❑ Yes [TNo
❑ Yes [TTo
❑ Yes OErNo
❑ Yes dNo
❑ Yes E No
❑ Yes 2 No
❑ Yes [l"No
❑ Yes [(No
❑ Yes. 2No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
violations deficiencies were noted during this visit. Youwillreceive no further correspondence about this visit.
�/�N`+of� ao�r
dditional WaauaW�l tS�7L1Wi+�FLi311I1i1� t
/10 06L" �bw,� - (A"rs
H.,
1.2/12103

r Site Requires Immediate Attention:u
Facility No. Z - 5-Zq
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: u , 1995
Time: 1
Farm Name/Owner: L (- Q 161 _/ J r_c,1-1
Mailing Address: X Y
County: C, 41;1}0'-%
Integrator c, .—z - - _ Phone:
On Site Representative: /- fi ,- c Phone:
Physical Address/Location: )P
C d:5
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: - f 4 � � Number of Animals on Site: S^D_ nu jc"t _'-/00 firz.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° " Longitude: , '
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Ue or
Was any seepage observed from the lagoo
Is adequate land available for spray? (esi
Crop(s) being utilized:
No Actual Freeboard: r:A Ft. (o Inches
n(s)? Yes or io Was any erosion observed? Yes or No
or No Is the cover crop adequate? � or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings) to No
100 Feet from Wells') or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orvo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or l� 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)? Yes or No
Additional Comments:
. ze:�� (_;)�
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Farm Name/Owner:
Site Requires Immediate Attention: PO;
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
ff
^rSo
Time:
Mailing Address:
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/1-ceation:
Type of Operation: Swine Poultry Cattle
Design Capacity: /A&A _ Number of Animals on Site: , ! +�� _ + ' �!
DEM Certifi� ation Number: ACE DEM Certification Number: 3VCNEW
Latitude: Longitude:"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: Ft. --6,.-Inches
Was any seepage observed from the la oon(s)? Yes or tjas any erosion ob ed? Yes or No
Is adequate land available for %spray? es r No Is the cover crop adequate? r e or No
Crop(s) being utilized: lct
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes r No
100 Feet from Wells?YeoQoc
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of state by man-made ditch, flushing system, or other
similar man-made devices? Yes orft If Yes, Please Explain_
Does the facility maintain adequate waste management record (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

R£GI5 ?kTy3N FORM FOR ANIMAL FEEDLOT OPERATIONS
Department, of Environment, health and Natural Resources
Division of Environmental Management
Water Quality Section
if r ---.e animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liauid waste system, t:^.en tris form must be f -4-1-1--d out and mailed
by December 31, 1,993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deerned permitted by DEM. Please print clearly.
m !��
Farm Name: - �r � %� p G FA r'."1 - -
Mailznc Address:fl�'
r/V, ZIP 5.73 ?y
Count,.,: S d=y.s 0 J Phone No.
n
Owner(s) Name. RQby Cru —dc r
Manage_ (s) Name: " 7'
Lessee Name:
arm Location (Be as specific as possible: road names, direction,
milepost, ECC.) : trQ Cl,'Ar 7akc- law �y6:Jrrf nnc ,.ills TurrJ Q�'rcGF7�d+Lf
VR /-.) 3.3) CYo M le Tvrr► L
r�[k` ltoUrL o.� f Ff � _ 6w•✓ �j��-1 [c 7-C, A�Gg F7,4 j-^-, -
Latitude/Lona:_•.:de if known:
Desian canaciry of animal waste management system (Number and type
C -f confined (s})0yj
—• a
Average animal population on the farm (Number and type of animal (s)
raised)* 40 �- 'Ied -rl.;f .�
Year Production Began: 19EV ASCS Tract No.:
Type of Waste Management System Used: �-4 Qe;,. Zrr► a ��,+/
Acres Available for Land Application of waste:�� Acre s
Owner (s) Signature (s) 0DATEd-
—
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