820610_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qual

1
! ivisipn of Water Resources•- - -
Faility Number ®- f
Fill Division of Soli and Water Consenatian
Q Other Agency
Type of Visit: -Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit. exoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region: 7 a
Farm Name: 0—j n, Owner Email.
Owner Name: r r~i .t Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,ter Phone:
Onsite Representative: ��u� Integrator:
Certified Operator: Certification Number: % 3
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
rr
Cuent
Design Carrent
Swine Capacity Pop.
Wet Poait y
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
❑ No
❑ NA
Da' Calf
Feeder to FinishDa"
[:]Yes
1
❑ NA
Heifer
Farrow to Wean
Design
Current
Da Cow
Farrow to Feeder
D , Poultr,
Ca aci
P,a
Nan -Dai
2. Is there evidence of a past discharge from any part of the operation?
Farrow to Finish
La ers
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Beef Stocker
Gilts
Non -La ers
of the State other than from a discharge?
Beef Feeder
Boars
Pullets
Beef Brood Cow
fiI
ITurkeys
Other
Turke Poults
Other
MOther
Discharaes and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]Yes
❑No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? ([f yes, notify DWR)
[]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesF��rto
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

1~ acili Number: - (p t) Date of Inspection: &/ O
Waste Collection & Treatment
/ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EKO ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _� 9
Observed Freeboard (in): q3
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes6N-o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[D<o
❑ NA
❑ NE
waste management or closure plan?
NA
❑ NE
the appropriate box.
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
Erg()
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L3 1`o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes dN
❑ NA
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
[3"9'o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. U Yes [j] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Approved Area
12. Crop Type(s): #r3nj&- l o a , S'-nge _
13. Soil Type(s): ^_ 10ok 1 _,�joZ /_L-7-`fJ A 1 � Ddb
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes E j o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ea<o ❑ NA ❑ NE
16. Did the facility tail 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 dNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA] NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes ❑'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ /,ease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes dN
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ YesNo
❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
E3//o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[K No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ Ne
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes El -No ❑ NA 0 NE
❑ Yes EJ No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes Ej"No
❑ Yes 2Ko
❑ Yes E3<o
❑ NA ❑ NE
❑NA 0 N
❑NA ❑NE
Comments (refer toquestion Explain any YES answers and/or any additional recommendations or any other corirments.- ,
Use drawing45s^of factliO to.bettO..,egplain situiktions (use additional ni;iies as necessary): '
�± .m `tih'
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3of3
Phone: 2/-0-303-0 LT1
Date: 2j'—"P-
21412015
j': �
2/4/20!5

ivisioTaf Water Resonrees
Facility Number - (r ! t7 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint Q Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: 7 — 7 Arrival Time; ; t7 Departure Time: 1fSJ County: Region:
Farm Name:
❑ Yes
T if
Farr,
Owner Name:
(�
etCapacity
/��r-i
Pop.
Cattle C*apscity Pog,
^
Mailing Address:
Physical Address:
Owner Email:
Phone:
la aeility Contact: f Title: C9Gc✓ri Phone:
Onsite Representative: �� Integrator:
Certified Operator: ��t�..� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design CurrentMDe—sI�n�current
❑ Yes
❑ No
0 NA
Design Current
c. What is the estimated volume that reached waters of the State (gallons)?
etCapacity
Pop.
Cattle C*apscity Pog,
Wean to Finish
Layer
I
❑ NA
❑ NE
Dairy Cow
Wean to Feeder
I iNon-Layer
I
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Calf
Feeder to Finish D S`
❑ NA
❑ NE
of the State other than from a discharge?
Dairy Heifer
Farrow to Wean
Desig13
Current
Dry Cow
Farrow to Feeder
D , P,oul
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'Turkeys
t]ther
Turke Poults
Qther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes allo 0 NA ❑ NE
[:]Yes ❑ No O NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
0 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 past discharge from any part of the operation?
❑ Yes
JaNo
[] 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 21412015 Continued

Facili Number: - & I D 1 jDate of Inspection:
j —1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
12 No
❑ NA
❑ NE
a_ if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Callo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[-]Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 12 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 E] Application Outside of Approved Area
12. Crop Types): �irudtac A r4
13. Soil Type(s): fj p (4 1 pJo,]3 /&-p4 f _3o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes jqNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C�g_No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,2S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ W UP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 3,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12�No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/412015 Continued

acili Number: - Co / Date of Inspection: 2 _f �
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fo No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, cheek [:]Yes CE[No ❑ NA ❑ NE
the appropriate box(es) below.
n Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
O_No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[ 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
M No
❑ NA 0 NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
�&No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ca -No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
D Yes
f,No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[FjNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C..No
❑ NA ❑ NE
Reviewer/Inspector Name:
ReviewerfInspector Signatui
Page 3 of 3
Phone:
Date: *0' - > / '- -)
2/412015

Type of Visit: t'Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: &IGUtine O Complaint O Follow-up Q Referral Q Eme ency Q Other 0 Denied Access
Date of Visit: — I
.Arrival Time:
Departure Time: ' County:
Region:
Farm Name:
Swine Capacity Pop.
Owner Email:
Capacity
Owner Name: we- r 1 Phone:
Mailing Address: eV
Physical Address:
Facility Contact: c % Title: Phone:
Onsite Representative: �,.�„t� Integrator:! d7
Certified Operator:S'ocr�� r Certification Number: � 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul.
Ca aci
Plko .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes FR No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No [3NA FINE
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 DWI) []Yes ❑No [JNA ❑ NE
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [RLNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �No [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - IDate of Inspection: — — 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ;Z_No
a. If yes, is waste level into the structural freeboard? ❑ Yes T❑ No
Identifier:
[] NA ❑ NE
[:INA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): 13 ,G 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ED No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ELNo
❑ 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
J�j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Imo, No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [KNo ❑ NA ❑ NE
❑ Excessive Ponding 0 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): _L2' �
13. Soil Type(s): 1,10,4
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 5a No ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fo_No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [}]G No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reguired Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [a No [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JE 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 CR N
❑ Waste Application [D Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
F] Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections El Monthly and t" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ©-No
No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑NA ❑NE
Page 2 of 2/4/2015 Continued

Faclli Number: - pJ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® 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
❑ Yes
[Z No
List structure(s) and date of first survey indicating non-compliance:
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes [3 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes UjNo
❑ NA ❑ NE
Other Issues
❑ NA
❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ® No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
❑ NE
34. Does the facility require a follow-up visit by the same agency?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes IK No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes ® No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Z No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[a No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:,J�/�
Date: ��'! .9�%✓�.
21412015

Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: 0tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: DRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O County: ,. Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
r
Facility Contact: 't- Zf �, �, ,ey/ T �2= Title: &z)ll "s,-- Phone:
Onsite Representative: , ,�Integrator:
Certified Operator: Certification Number: j
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er 11 E�d
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes M No []NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes Q No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - p jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
BNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): 1 �}
Observed Freeboard (in): _ f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ 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)t'�//Y1�.� /� L -rS�Y (�� ` /
13. Soil Type(s): (� No 14 F0 [�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ N A ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes jj4 No ❑ N A ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ N E
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes]
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

"-.',
FaciliNumber: rte— - (�) p Date of Inspection:
r 24. Did the -facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
;. 25, is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ® 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 [R No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[.Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[]Yes [A No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® NNcos ❑ NA ❑ NE
0—Yes No ❑ NA [] NE
❑ Yes ® No
[:]Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explain any�YES. answers and/or any additional recommendations: or any other comments
er ex_P lamsituations(use additional pages as necessa
ry).Use drawings of facility to bett:
A
Reviewerhnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

ff6- r
11MEaciUMNUM—MIp� �
Type of Visit: EMomphance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: G"toutine O Complaint 0 Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: %'r 1�-1 Arrival Time: ', O.0 Departure Time: A' ;t: ,aD County: J,�F7 Region:
Farm Name:r Fa {Yh- Owner Email:
Owner Name: - j -E i f fakif A-�- f� L � Phone:
Mailing Address:
Physical Address:
Facility Contact:
`gyp Werri' i rt2 Title:. e r r -
47
Integrator:
Certification Number:
Onsite Representative:
Certified Operator:
Phone:
Back-up Operator: Certification Number:
Location of Farm.
Latitude:
Longitude:
EK Design Cnrreutt
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
Wean to Finish
La er
[:]No
❑ NA
ow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Yes
❑ No
❑ NA
Da' Heifer
Farrow to Wean
❑ Yes
Design
Currei5t
Dry Cow
Farrow to Feeder
D , Poul
Ca act
P,o :.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Turke s
-
Other
Turkey Poults
Other
Other
Dischames and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
5jLNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
E] Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Callo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
54 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: - (o / Date of Inspection:
Waste Collection & Treatment
+ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9 1 9
Observed Freeboard (in). t 31Zs
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 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?
M Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5§ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p 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
7�
12. Crop Type(s): rMj10L tltlY�Sz'rnf �Ci�/ ✓L /LCI r I s �7C>�c� •� �Go�7z1�-
13. Soil Type(s): O ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes U 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 2[ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
[:]Yes EB No ❑ NA ❑ NE
[:]Yes ®-No ❑ NA [:]NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E&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. M Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield.120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes FZ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA [] NE
Page 2 of 3 2/4/2011 Continued

[Facility Number: 175ate of Inspection: T
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a 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 stmcture(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)
3I . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Dg -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
t8 No
❑ NA
❑ NE
❑ Yes
J�S No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
E@ Yes ❑ No ❑ NA ❑ NE
Yes No
[] Yes No
0 Yes ®,No
❑ NA ❑ NE
[:INA ONE
❑ NA ❑ NE
Comments (refer to question #l): 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).
r x.
7a Ct3-y►� %�"�'r W �� ate.. L,�y� r..,.�� S.
c j7 ct- 2-- e e iHr� F=D ,'M - Tv 5hz -'-j
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone. 9/ v— xM 33
Date: 7f-/— / 4
214/2011

ONS t- c 10110it3
Type of Visit: t�Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: & Routine O Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: [�01311 Arrival Time: Departure Time:;�Q County:.
Farm Name: 3t4 5&m Owner Email:
Owner Name: 321.81 1�._f �I ele Phone:
Mailing Address:
Region: P,O
Physical Address: 3417 DUt I NeE 6(00—
Facility Contact: 3, 0%1(1-� Title: 0 L Phone:
Onsite Representative: Zrp f+ ((j q Integrator: ! �Q
Certified Operator: � / A. il-AQ Certification Number: 1Q D3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [RNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
[:]Yes ❑No
❑ Yes Dg No
[:]Yes C'No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA 0 N
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/412011 Continued
Desig�nC`rrent
Design
Cu rrent
Design Current
Swine;
Capaty,op.
Wet Poultry
= Capacity
Pop.
Cattle Capacity Pop.
can to Finish
La er
Dairy Cow
canto FeederNon-La
er
D Calf
Feeder to Finish
_
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
P„o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [RNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
[:]Yes ❑No
❑ Yes Dg No
[:]Yes C'No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA 0 N
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/412011 Continued

Racili Number; - ED at iof Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[3 Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Cj 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
[R No
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ra No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[$No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
UR 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
CS No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[-]Yes
[�kNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
C�ZNo
❑ 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. CropType(s): C�4�]lt I7f:�rtL+<
C��t'
13. Soil Type(s): lnfli/�fhar A tzl l tom, Lain,.,
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
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
[S No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[52 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CR 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 rRNo ❑ 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 [8 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No D4 NA ❑ NE
Page 2 of 3 214/2011 Continued

F,aciti Number•
Date of Inspection: '�A
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:] Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
No ❑ NA ❑ NE
M No [DNA ONE
[] 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 ER -No [:] NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:] Yes [:] No [-NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
59 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?
F] Yes allo [—] NA ❑ NE
Yes 10 No [-] NA [:] NE
Yes No [] NA NE
f'Yes [:]No ❑ NA ❑ NE
Yes 12 No
[] Yes Eff No
E] Yes DZNo
❑ NA [] NE
0 NA NE
NA NE
Comments (refer to question ##): ExpIain any.YES answers and/or any additional recommendations or any otfi_er corn_ m- encs. "
r
Use drawings of facility to better explain. situations (use additional pages as necessary)
y, NfWR4IS (rf Ind -(r row ('rot on flai k,+h --e coM4 *,,Wk h No woieho,-
f 1 sr`YICE AA hLi P�On �r7� �'��roc inPc{ i C� � •
x/01), *je- ruil
God -fields 014 '(P(O-ds,
WAOVI rdvuff (tv 1.
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Srhitpf-
'P
Phone:9IC—qn- 3� ff
,
Date: ua :3
214/2011

Facility No,
/a-�>' o Farm ��
Name t Date
Permit -/ COC OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
r
Lagoon Name, S for spilKvay 1 2 3 4 5 6 7
Design Freeboard ! Last Recorded (in)�-
Observed freeboard
Sludge Survey Date I
Sludge Depth ft -9,
Liquid Trt. Zone ft7 $,as 3
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Soil Test Date 13 � C�JA f1
Crop Yield
Transfer Sheets
pH Fields fPl
Wettable Acres
RAW AUG£ .�
Lime Needed Q_..
WUP
ead bo r incinerator
Lime Applied
Weekly Freeboard
Mo a i Records
Cu -I Zn -I
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp_
Storm Water
Needs P
Weather Codes
ELT M- rm In. - Rs'h�LJi[��r7ti7C7�1'��'�
oil M-
i �M. 'M O:
RON 0 M
..at
Y .
N 303-
Ye i �&E NUMBERS and affiliations DI)T'
Date last WUP FRO FRO or Farm Records
Date last WUP at far njl(� Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/acLiq
" 3
3aox.�o

q i [
ype oz v [sit. W t_,ompuauce inspection v %jperanon review V mructure Eva[uanon V ieenmeai Assistance
Reason for Visit: -0 Routine Q Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: al County: rd�
Farm Name: J_f ' f05/41 Owner Email:
Owner Name: ;a£ffj Mend" Phone:
r
Mailing Address:
Physical Address:
Region: f"
Facility Contact: jT lefd a Title: OW/1&- _ Phone:
Onsite Representative: p f 1 �_ _ Integrator:
Certified Operator: j f ir),il W Certification Number: j -! 3Q3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Yes (-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
'�
❑ NA
Design
Current
Design C►utrent
Swine
CapacityWet
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
Poultill!ML)
Capacity
Pap. Cattle Capaci#y Pop.
❑ NE
Wean to Finish
❑ Yes
S No
Layer
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Cow
® No
❑ NA
Wean to Feeder Non -La er
Da'y Calf
Feeder to Finish
Q
;
Da'y Heifer
Farrow to Wean
Design
Cnrreat
Dry Cow
Farrow to Feeder
Dr. P,aui
Ca aci
P.o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
—.Layers
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other
Other
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Yes (-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
S No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

1117twility Number: T2k, - Date of Inspection:
❑ NE
❑ NA
❑ NE
❑ NA
Waste Collection & Treatment
❑ NA
❑ NE
❑NA
❑NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ea No
❑ NA
❑ NE
a, If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑] NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):q —�
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W No
0 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
JR�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
C' No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(R No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Callo
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolicatlon
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
at No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
fl;a No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving; crops differ
those designated in the CA W MP?
15. Does the receiving crop and/or land application site need improvement'?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
® Yes D No
❑ Yes 15 No
❑ Yes ® No
❑ Yes No
Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA [3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W 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 Co No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes *f No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No
E] NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA E:] NE
eTNA ❑ NE
Page 2 of 3 214/2011 Continued

Facility Number: 4"N' - l J'n I IDate of Insr►ection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Yes
No
❑ NA
❑ Non-compliant sludge levels in any lagoon
If yes, contact a regional Air Quality representative immediately.
List structure(s) and date of first survey indicating non-compliance;
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
21 No
❑ NA
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[allo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
E)�iVA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ No
❑ NA
[] NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
21 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3l. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
[�YYes
❑ No
❑ NA
[D NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
k'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative'?
❑ Yes
5� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ff No
❑ NA
❑ NE
Comments (refer to goestlon #) %Explain any YES answers and/or, an additional recommendatrions' r other comments.
Use d6"' inQs of facility;to"t"ie ter ezulain situations'fuse:ad�itiona!'oa�es as nee"essarvl:'
d i_Zi=-
an
31, 401wK ie I'A tAl T,
]y, 'WA.sf-_ Flo, needy ip be. mod,"A"&L+o covo­ hay no+ POWU©PS, b
F eldr w� addttt a � au/u o � K the C hu
SS �f 1 r rfi� 1
n r c41 a c� _7o c
Ter_� � ���L a b��~ ro�Fo g
S �oklt char — wif 11 ble _MW 0r sarr a (or -PJ /t)
9V
coven,
- -i 1dwar
Nd� � � Q �
Reviewer/Inspector Name: 70,9',
n n _
Reviewer/Inspector Signature:
Page 3 of 3
Phone: of 0'43 _a 1
Date: 12f
/4/2011

Facility No. $ �' io Farm Name
Permit % COG
J -H- Date 'Afl l a
OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last•Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
1/
Verify PHONE NUMBERS and affiliations
Date last WUP FRO q-4-00 # FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversio ,CCu-1 3000= 108 Ib/ac; Zn -1 3000= 213 Ib/ac
P'y
tDKt=)K9M
Soil Test Date
lhi LTi" IfIA / IFe.
Crop Yield -�
Actual Flow
pH Fields
- lit! -
I►----�-
RAIN GAUGE
Lime Needed
Verify PHONE NUMBERS and affiliations
Date last WUP FRO q-4-00 # FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversio ,CCu-1 3000= 108 Ib/ac; Zn -1 3000= 213 Ib/ac
P'y
tDKt=)K9M
Soil Test Date
lhi LTi" IfIA / IFe.
Crop Yield -�
Transfer Sheets
pH Fields
f,�ldia f i ►�
Wettable Acres T
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied WA
I
Weekly Freeboard
Mortality Records
Cu -I --"- Zn -I
1 in Inspections
Check Lists
Needs S (S-1<25)
Needs P
_ flfP3f1
120 min Insp_
Weather Codes
Storm Water
Verify PHONE NUMBERS and affiliations
Date last WUP FRO q-4-00 # FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversio ,CCu-1 3000= 108 Ib/ac; Zn -1 3000= 213 Ib/ac
P'y
tDKt=)K9M
lhi LTi" IfIA / IFe.
13,001"OWN
I i t
f,�ldia f i ►�
Ilvri■
M�
�� �OL
ix
3
Verify PHONE NUMBERS and affiliations
Date last WUP FRO q-4-00 # FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversio ,CCu-1 3000= 108 Ib/ac; Zn -1 3000= 213 Ib/ac
P'y
tDKt=)K9M

: ype or visit: Ky li- ompiiance inspection %.j vperniton nevlew V structure Evaluation L} i ecnnical Assistance
Reason for Visit: 9 Routine 0 Complaint 0 Follow -tip 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LLILLJ Arrival Time: whr Departure Time: County �� Region: -
Farm Name: F&M Owner Email:
n
Owner Name:h Phone:
Mailing Address;
Physical Address:
r I
Facility Contact: *1q"etd Title: (9 � � Phone:
Onsite Representative: lvf[A. Integrator:
Certified Operator: Qy ej(In*t Certification Number: 1g3a3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWQ)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CR No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [] No
❑ Yes []No
❑ Yes Cq No
❑ Yes CR -No
D NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
DNA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Vet Poultry "'
Capacity
Pop.
C«attle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
-Layer
Dai Calf
Feeder to Finish
" ""''
Dai Heifer
Farrow to Wean
=tea;.
Design
Ceirreat
Cow
Farrow to Feeder
D . lY,ault .
C$ aei
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
1101 11
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CR No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [] No
❑ Yes []No
❑ Yes Cq No
❑ Yes CR -No
D NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
DNA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - LP Date of Ins ection: 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �S 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): 3y- 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ 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?
g Yes
❑ No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
5g'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. [] Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
lY SO
b�
13. Soil Type(s): Alyvo is B`
dp U G
14. Do the receiving crops differ from those designated in the CAWM
❑ Yes
E;�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ YesNo
E]NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
f�jNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E':�-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
CE17Yes
❑ No
❑ NA
❑ NE
the appropriate box.
f j],WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes rg No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
aNA ❑ NE
Page 2 of 3 2/412011 Continued

1.acili ,Number: k Date 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 ®-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
my YES.answers and/or any additional recomniei
situations 6- ie. as nece§sary)
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
❑ No
PSINA
[] NE
[:]Yes
RNo
❑ NA
❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
a Yes ❑ No ❑ NA ❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
[—]Yes
[2 -No
❑ NA
❑ NE
�. t'l&e, work a, bve. sf �_f oo batfi la m4j , Sone- work doi e Si�(e l au-1yam.
Pol I � wor d emek I asf K') ' or I T/0 cte_,
a 0. P i2#,e �o ve1 N��e A od �fi 4 �?r Stl wm r e(vt,� of) t)
s h iva� do � cr y'yJm f' Cro films
s12 Serve fora01 . �"�� nP Isprue cam.
a� � �efi� f �, ,�- �.s I �d� Ys n x y�
3 E, Drow�'fi f_ &r Full st
ccer'[ or n coed a Ix vel &mfl Pfd sJ ate. rem -d .- a -e i� jc�'rh
keMfnd+ N oide'sal les are oat 0day s, tvo F ern fvadaPJwi
[Jq )MAV )' He._ a bo, l;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
!} �o8�r c
Phone: vl'1l-y.3.-333-37
Date: o� 01 a
2412011

Facility No. V- 110 Farm Name f� ��� Date l
Permit COC OIC, NPDES (Rainbreaker PLAT Annual Cert }
Pop. Design Current
Type
1• illway
freeboard
Observed freebqa[d_Cm)--.
Sludge Survey_Date
---��--
Slu
.. - Deph
-------�
Design Flow
Actual
•
_DeM�n Width
Soil Test Date I, i y� II �sh� Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator .�
Lime Needed 0- OR MC Weekly Freeboard Mortality Records 1
Lime Appliedi�k, 1 in Inspections -/
Cu -I / Zn -1 � 120 min Insp.
Needs P Weather Codes
Crop Yield Transfer Sheets
Waste Analysis Date 5 I
- 60 Da 3
+ BO Da i
N Amt Ib11000 Gal 3,0 a,
pH
:MIN.. ..111111111117
terify PHONE UMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records L50 13- Vg
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lblac; Zn -I 3000- 213 lb/ac
App. Hardware
I

r.
Type Of Visit VCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: [TiNTIE Departure Time: County: SSOr Region: FRO
Farm Name; F01,11 Owner Email:
Owner Name: 4 k T�l(� Phone:
Mailing Address:
Physical Address:
Facility Contact: a e*t f x 4-eakg Title: 0 'n& Phone No:
Onsite Representative: Integrator: 1
Certified Operator: � � f ita 4 Operator Certification Number: 1132.1
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = 0 =I
= u Longitude: = ° =I
= x
Design Current
Swine Capacity Population
❑ Wean to Finish
Design Current
Wet Pauftry Capacity Population
JE1 Layer
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ NE
❑ Wean to Feeder
❑ Non -La er
❑ NA
❑ Dairy Calf
Feeder to Finish tLJ190
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ No
El
Farrow to Finish
❑ Layers
Beef❑
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
El Turkeys
Other
❑ Other
❑ Turke Poults
10Other Ihlutnber
of Structures:LA
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 7E�LNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 7 — oo I Date of Inspection
Soil type(s)
1
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Waste Collection & Treatment
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes TS No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Is there a lack of properly operating waste application equipment?
❑ Yes
E,�No
Spillway?:
Comments (refer to question #): Explain any YES'answers and/or aQy recommendations or any other camuients -
ri.'
Use
Designed Freeboard (in): — q
Observed Freeboard (in): -r-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes N 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 allo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [5,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 [K No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 15 No ❑ NA ❑ NE
maintenance/improvement? `
11. Is there evidence of incorrect application? If yes, check the appropriate box below- ❑ Yes I"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
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t, No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
53 No ❑ NA ❑ NI -
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ESNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
E,�No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES'answers and/or aQy recommendations or any other camuients -
ri.'
Use
drawings of facility to better explain situations. (use additionalpages as. necessary
Reviewer/Inspector Name �� i r� ,L4, .Phone: ( 1 JV 33aox3- 3
Reviewer/Inspector Signature: jn&_P't& Date: NW I. QQ)
Page 2 of 3 U 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CgNo ❑ 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
JP No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
�JNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�lo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT") certification?
❑ Yes
❑ No
TRNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C'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
IgNo
❑ 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
15JNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
BNO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
aNe
❑ NA
❑ NE
Additional Comments andfor Drawings:
3y. 4ii� drab t�r I� Q n ��1 l
Is, tam a ocr► a . G �'. ���� rvtxlC on 0, l'ew Erre s�
-7, C -c cf'I `� cam
law chd_. mow ba costa e,
�°
�y
1� Maf Pldr I imFd-hi s r;� 6(ow - pfo�s � me �rPres�i o C�say�°Q�
� j yLor'�
PiO)e- Cal; bye f9Y�t � / A
t t
S E�1�►� bion sly s evej Ala a
600d. re(odr a►d v7 ivell rnokfaiWat -ears.
Page 3 of 3 12/28/04

Facility No_ $�`�Pi Q Farm Name
Permit COC ✓
Pop. Design Current
Type
fit] {der c,
�1 Date f
OIC NPDES (Rainbreaker PLAT Annual Cert j
FB
Drops
Lagoon 1 2 3 4 5 6 7
S illwa
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt_ Zone ft
Ratio Sludge to Treatment Volume
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu -I
Needs P�'G
Crop Yield
RAIN GAUGE
WUP I--, Dead box or incinerator
i-1.3 4"b Weekly Freeboard '- ` Mortality Records
1 in Inspections ✓_
Zn -I 120 min Insp. s„f
Weather Codes
Transfer Sheets
..
..
■�
91 =�■
Verify PHONE NUMBERS and affiliations �� }—
Date last WUP FROG( 0t,, Date' st WUP at farm App, Hardware(
FRO or Farm Records
Lagoon #
Top Dike 31
Stop Pump
Start Pump 5
Conversion- Cu -I 3000= 108 lb)ac; Zn -I 3000= 213 Iblac

fmS \Yvl 6 1131
0
Type of Visit grCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time:
Date of Visit:KHI�lrr
Departure Time: lso ptl County: M J
Region: FRO
++
Farm Name:
Wet Poultry Capacity Population
Owner Email:
❑ Wean to Finish I
ID Laver I
r
❑ Wean to Feeder
110 Non -Layer I
Owner Name:
Naw-
Mailing Address:
Feeder to Finish
Phone:
Nfw G�o��
❑ Dairy Heifer
Is
�s `~ p
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Physical Address:
❑ Layers s
❑ Beef Stocker
❑ Gilts
ti
r
��� 0 (C
Facility Contact:
Title:
Phone No:
❑ Turkes
Onsite Representative:
1 M
! 11%
Integrator: V
❑ Other '
❑ Other
Certified Operator:
r 1
Operator Certification Number: 3
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: =0
01 =u Longitude: =°
=' 0 W
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish I
ID Laver I
❑ Dairy Cow
❑ Wean to Feeder
110 Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ NE
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers s
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl
❑ Turkes
Other
❑ Turkey Poults
❑ Other '
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. 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 qNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RS No ❑ NA ❑ NE
❑ Yes IRNo ❑ NA ❑ NE
12128104 Continued

Facility Number: $a — Date of Inspection �
Waste f'ollection & Treatntent
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
Sinicture I Strijefure ? Strnscture 3 Structure 4 Structure 5 Stnicture 6
Identifier:
❑ Yes
Spillway?: _1433F
❑ NA
Designed Freeboard (in): 1
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): �S
❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
�RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
El Yes
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
RNo ❑ NA ❑ NE
through a waste management or closure plant?
17. Does the facility lack adequate acreage for land application?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
1.5
7. Do any of the structures need maintenance or improvement? FinYes
%No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes
o ❑ NA F1 NE
(Not applicable to roofed pits, dry stacks and/or wet statics)
❑ NA
9. Does any part of the waste management system other than the waste structures require D Yes
C�14o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
r>�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
I'Q-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sfudge into Bare Soil ,
CplI�43 RU �I
❑ Outside of Acceptable Crop Window n Evidence of Wind Drift El Application Outside of Area
7
//��
12. Crop type(s) 000j gi Beim -J&
'. Cc}b„'. l.'a'I.-507m," 0R
w_!
t`tT�iGLtiS D�e1
13. Soil type(s) RIF' -. wag F VvaB Is
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
i�kNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[RYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination-,
El Yes
CR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
J
Reviewer/Inspector Name ",TOA-0SC 'Fa Phone:(T110) q33-3300 X335
Reviewer/Inspector Signature: Date:
1212V#4' Continued

r 1�
Facility Number: g — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. t -Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield t;1,120 Minute Inspections [:]Monthly and V stain Inspections R Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
tR No
❑ NA
❑ NE
23.
if selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
RNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'UNo
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Elfi
No
S[NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tRNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Rio
❑ 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
ff No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
.9I No
❑ NA
❑ NE
AdditiaQal:Cornme�ts and/or Drarr�npps �-;;_;
.
CO&C weed -s al �,� ��II ( hof n&hey) S necON 1 ,
�
rC�d �rf� hl rr�a�s c a�c� -46��sa, to IQ wa Ib 's 4 n �5�et�r
7 � J
It�r�IQ,
S S 1 L, dj
I� P l('a,�S`�"S�'�r 1 RR 4� reurcy>rt rac mi�'I�s,pPc o -U,
s 1 �, I elk �ffllre�-01 Ord L, e- coo 9e�
p[eoe mac i Cho► e oddfw TO Vv P,5�
ajX&fPC�r�-
f n rvu cf ch
7
Page 3 of 3 12/28/04

q
00109 7vs -p )w
Type of Visit ®' Compliance inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Ja Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other Denied Acoess
Date of visit: Arrival Time: Departure Time: �� County: Ser, Region: ' r W0
Farm Name: ZT# FM Owner Email:
Owner Name: (f V Phone:
Mailing Address: jjjZ&j N4-61 -Awl C1 l _ 3a
Physical Address: �p
Facility Contact: i Title: Win&' Pbone No:
Onsite Representative: 4qrifAa Integrator:
Certified Operator: POperator Certification Number:AM1q.3d3
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: =0=1 = u
Swine
Destgie Cupreat
Ca aci +P0 uulat on
pmt, �'p
xDestgn�Current
W0 oultry 3 Ca activ�Po ulation
p��.._ �P
-
Design Current
Cattle Ca aci Po ulation
F h' p
Finish
❑ La er
❑Dai Cow
to feeder
❑ NE
❑Non -Layer
❑Dai Calf
r to Finish
E9 No
�
❑ Dai Heifer
to Wean❑
D Cow
to Feeder
4❑Non-DaiLa
Vto
to Finish
ers
❑ Beef Stocker
Non -La ers
Beef Feeder
❑ Pullets❑
Beef Brood Co�
- ` -`,
❑ Turke s❑
❑ Turke Pouits
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E9 No
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
12/28/04 Continued

12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t'No
Facility Number: Date of Inspection EMED
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
IRNo
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo ❑ 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:
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in): _19
Observed Freeboard (in): _ 01
5. Are there any immediate threats to the integrity of any of the structures observed'?
[]Yes
R No ❑ NA ❑ NE
(ief large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo ❑ 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?
'F3 Yes
❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0? No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo ❑ NA ❑ NE
maintenance/improvement?
]L _ Is there evidence of incorrect application? I f yes, check the appropriate box below.
❑ Yes
IN No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9 No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
115JNo
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
{?[Yo
❑ NA
❑ NE
i�`�4in:.u,� : `�16 a � a �.,,�.h1a°r,"eVr`ssa+::�tiu.��e.'.".!�°"z� ;y
Comments (refer to gnestton #) Etcplatn�any�YES,answers andlor anygcecommendlapoos or any other comments,
1a> -., +r�r"3 .. " f. l v f y} ';'p$ �.�-+star: !�' ar '
W, drawn s of factli60"o letter.exUlaifiWtuattons (nSeyaddttional pag as;necessary):
ReviewerlInspector Name Phone:91 IL3
Reviewer/Inspector Signature: Date: $ 8
Page 2 of 3 V 12128104 Corrtinned

Facility Number: Date of inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes JRNo [:INA ❑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
CR No
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CRNA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CR 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
3 t.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Rio
❑ 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
E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
aaLCoatmints aadlirr i)rawings ^� ` �,, �.-�� y x� r, -t.
Additio. .
�. P&P, orcPd �o�so`r 1, Jew % m v ich -b ode bin ks of
���
I. a h dr �oo,d ave-, A Hie- b j1- � �o�h r r r
aLt Pier ha.- eabilAb, date 1Irye Q
WieweVI4 w� cewd- 01 w�-side, pPe, rias
be f1&" �j oTb-h 'ir >"k49-
604 record r 4 job [ext -eft 11m) c"A na)%#. Qbv,,e),
fled ernc�e. ha endo r,
Page 3 of 3 12/28/04

Facility No. �a-r�Farm Name
Permit Z COC _
Pop.Type Desi n Current
-j4 Date $ �!
OIC_s,ee NPDES (Rainbreaker PLAT Annual Cert)
R •e
Lagoon 1 2 3 4 5
6 7
Spillway
Design freeboard 3
i i�01 0
Lagoon 1 2 3 4 5
6 7
Spillway
Design freeboard 3
i i�01 0
Observed freeboard i
Sludge Survey D te9jjtF& Perm Liquid ft
Sludge Depth ftS
-Calibration Date
fJ.esign Flow�+T�------
Design Actual Width
Soil Test Date W fab I 1 in Inspections ✓
pH Fields Crop Yield 120 min Inspections �^
Lime Needed Wettable Acres ✓ Weather Codes
Lime Applie 3 WUP Transfer Sheets
Cu Zn Weekly Freeboard i' RAIN GAUGE
Needs P Rainfall >1" T
Waste Analysis Date
- 60 Day _
+ 60 Da
N Amt(lb/1000 Gal 3
H
1 r 609 160 wo ,&i TDA l�
Date of last WUP FRO Date of last WUP at farnal11 9 bf Aon. Hardware Max.Rate Max Amt !
Verify phone numbers and affiliations
��
-D 44- (9 o
4o.q 10,4 43,1=4&-V( _5ivr
fbp 3&9 45r3 ---�a
33, Lf Say
Lr
��rff3
�1
—17or
i i�01 0
O.. - , <, . ■■��
Verify phone numbers and affiliations
��
-D 44- (9 o
4o.q 10,4 43,1=4&-V( _5ivr
fbp 3&9 45r3 ---�a
33, Lf Say
Lr
��rff3
�1
—17or

Facility "dumber: 4Z — (QJo Date of lnspectioo
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes m No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure d Structure 5 Structure 6
Identifier: Z_
Spillway?:
Designed Freeboard (in): ! Ict
Observed Freeboard (in): 32— S
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes[ No ElNA El 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 W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Pd No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
[INA
❑NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
qV No
El NA
C3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JR 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
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A&
Reviewer/Inspector Name CAZIS-OPOZ UANMAJPhone: cl y33 3M
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: "ice [O Date of Inspection 1 i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, cheek the appropriate box below. ❑ Yes % No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
QQ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
DdNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t& No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F.No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[, No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) Certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
yu No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IM No
[:1NA
[:1NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Y resin-�11i 11�y'l of S >I1 "6y`j,PA
12/28/04

Facility No. OZ- `L0 t� Time in �7 Time Out Date ,t
Farm Name 0—Y Integrator s�
Owner Site Rep
Operator No. No. Z 1 -
Back-up No.
COC _�� Circfe: era or NPDES
Design Current-
Design Current
Wean – Feed
Farrow – Feed
Wean – inish
Farrow – Finish
,-Feed – Fi
Gilts 1 Boars
Far—row – can
Others
FREEBOARD: Design
Sludge Survey
G
Crop Yield L� UI
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard �� Daily Rainfall
Spray/Freeboard Drop Apt, Jv� ,
Weather Codes 120 min Inspections _
Waste Analysis:
Date Nitrogen (N)
Observed
Calibration/GPM 1 Z 6
Waste Transfers
Rain Breaker -------
PLAT
n Inspectio y
Date Nitrogen (N)
_Z/ZJ -.>,.Z
n6 �C
PulllField Soil Crop
Pan Window
C C)

Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 00ther ElDenied Accessi (� }
Date of Visit: (�
Arrival to a��p Arral Time: Departure Time: County: `^ sbyl Region:
Farm Name: ._l. fS _ Owner Email:
Owner Name: __S7 f I+
Mailing Address:
Physical Address:
Facility Contact: I k Title:
Onsite Representative:
Certified Operator: �- I
Back-up Operator:
Mn4n
Phone No: 1
Integrator:(` ��'li urn SA��gY C
Operator Certification Number: 13
Back-up Certification Number:
Location of Farm: Latitude: =10 =11 ="
Longitude: =0=1 a u
��EurrentineSwpula#ion
❑ Wean to Finish _
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design C•arrent
Wet Poultry Capacity R,opulatiott
❑ Layer
❑ Non -Layer
— — R
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf I j
❑ DaJEX Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges &Stream Impacts
-1
1. Is any discharge observed from any part of the operation?
Yes
El NA
[I NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
allo
PONA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0 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
MNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility. Number: --,Q {o Date of Inspection til IQ(0166
TWaste 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 fi-eeboard?
t S r cture I � c ure z Structure 3 Structure 4
Identifier.
Spillway?: I I
rf
Designed Freeboard (in): I
Observed Freeboard (in): .� 1 [�
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 To [INA [INE
Structure 5 �t Structure 6
❑ Yes IFNo ❑ NA ❑ NE
❑ Yes WjNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures Iack 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 EINE
maintenance or improvement?
Waste App Cation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes "% No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Froxen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> ]0% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
I
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ►►►h("` No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes *No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. use additional pages as necessary):
ReviewerAnspector Name
Reviewer/inspector Signature:
Page 2 of 3
R.iST11
Phone:
Date: �u
11/18104 Continued

.Fat i�ity Number: —lpi p Date of Inspection 1 1
Required _Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes A No ❑ NA ❑ NE
the appropriate box_ ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes btNo ❑ 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 KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ',No [INA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ANo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 2lo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in Charge? ❑ Yes M.,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes'ZNo El NA El NE
Other Issues
w 9'`QXI
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
tyNo
❑ 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
10 No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
PkNo
❑ NA
❑ NE
Additional Comments and/or Drawings: u
w 9'`QXI
r
Page 3 of 3 12/28/04

Type of Visit 0 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: y a s- Arrival Time: `so Departure Time: County: ��"Sios'6n Region: FRO
Farm Name: T H• Fiacm Owner Email:
Owner Name: -TeA�' &0'rk #Inn Phone: 21,/0_„Q_YL 2229
Mailing Address: _ /I "96'] NarfA N", --
Physical Address:
Facility Contact: Teff llerr,:,a Title: Phone No: 9/0-��5gd• /ldl
Onsite Representative: T W Integrator: -e."'" .S7fn. 'ar
Certified Operator: , eIr Operator Certification Number: /13.23
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 [=,
=11 Longitude: =0='
Design Current• Destgn Curreat'"Designt� Current
Swine Capacity PopuEahoeonit5',nt'PCapactty 1'opulahon�C Capacity Poptiiation
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer 1 ❑ Dairy Calf
Q ceder to Finish LIQ&G raa�-;<. }t rte t ❑ Dairy Heifer
r
❑ Farrow to Wean' $` ❑ Dry Cow
�i�aD�' �
El Farrow to Feeder �``' ❑ Non -Dairy
El Farrow to FinishEl Layers ❑ Beef Stocker
❑
❑ Non -La ers
Gilts ``. El Beef Feeder
kY
❑
Boars El Pullets ❑ El Beef Broad Cod
- -
Turkeys
F 3
Other x' ❑ Turke Poults �zx:
❑ Other ❑ Other ix'+.Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ll -go
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management systemY (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[ o
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�FiQo
❑ NA
EINE
other than from a discharge?
12/28/04
Continued

Comments�(refer�to gn�stton"#) �Explam any YES answers and/or,any'recomr
[Ise draRzngs ofifac�ty"totbet#errCAPI brt situahoas . (use addittont la astf
Reviewer/Inspector Name r k ra flAft, Phone: 110
Reviewer/Inspector Signature: B Date: 3- S -o S-
IF Continued
Facility Number: 8 — (r�0 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 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: •_If '2
Spillway?: no 40
Designed Freeboard (in):
Observed Freeboard (in): 2 (jam
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ONo ❑ 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
[rNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ONo ❑ 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
0'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[QNo ❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ 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
a-aes /oo
;'Yrt,�,� q �o 1141 s
12. Crop type(s) B
+vGr^
_ er/�trs
—
13. Soil type(s) 4V,, 8} A.1
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
[TNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[-] Yes
❑ No ❑ NA ErNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA 2rNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo ❑ NA ❑ NE
Comments�(refer�to gn�stton"#) �Explam any YES answers and/or,any'recomr
[Ise draRzngs ofifac�ty"totbet#errCAPI brt situahoas . (use addittont la astf
Reviewer/Inspector Name r k ra flAft, Phone: 110
Reviewer/Inspector Signature: B Date: 3- S -o S-
IF Continued

Facility Number: g.) Date of Inspection l
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 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 appropirate box. i'�
❑ ��"' ❑ C.h�sts ❑ ❑ W ❑gtkd
21 _ Does record keeping need improvement? If yes, check the appropriate box below. [ 'fes 0 No ❑ NA ❑ NE
.7- Ay2-S,
❑ ❑ Wreid rftntMd ❑ A4W_Aa&L3sis ❑ lysis ❑ Ww te-Traysfers ❑
❑A*io� ❑ S4*kiftg ❑IGrep- hl ❑ s �onthly and 1" Rain Inspections ❑ WeatheK­ode
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
[TNo
❑ NA
❑ NE
❑ Yes
[rNo
❑ NA
❑ NE
❑ Yes
2hgo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
291E
❑ Yes E''lo ❑ NA ❑ NE
0 Yes 0'No ❑ NA ❑ NE
❑ Yes [21 No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
A(Midonal.0-66" rrifs ani%©r-+Drswris ' ' x` yy�� ••--SSJ[J
f 7�
�� l�av,Crvt� /}ldpf�%► a.,rl 1 �' IPc�,'.,-Zn.5��7�,o.,s
12/28/04

Type of Visit Qf Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit (d'Houtine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 D Date of Visit: � d Tune: �
Not Operational Q Below Threshold
Permitted Certified Q Conditionally Certified 0 Registered bate Last Operated or Above Threshold: __ __� ......._.
Sor►
Farm Name:_ •
........... �...... �c�M'±...._............. _...... .........._..................�...._..------- County
Owner Name:
..... ��.............ItL�S,..!!'��..........��........... Phone No:
Mailing Address:.......11.� b 1...... N° r�M ^ LI•� �7w N--------.................... L� rt i �► fr2►+ _ �N C
Facility Contact: 7cITS' S -1
.................................... Title:.......... b"!''!G.....--•--_.........................._.. PhoneNo:
Onsite Representative: --- SG�r--_ _?ti _ .... .... Integrator:rt'"
Certified Operator:._---- ! ___--------- Operator Certification Number;,,,,,,,,,,,,,,,,,_•,,,_.,,.,,_._
Location of Farm: /
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
DischMes & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 21ro
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other /
a. If discharge is observed, was the conveyance man-made? ❑ Yes LYNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
[I Yes [No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes/
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 81,10
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes dNo
Structure 3 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Iden[iffier: ................ .°�...... __ ........-
Freeboard (inches)-
12112103 Continued

.1
Facility Number: — /p
Date of Inspection 1..4,121 1614
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [I Frozen Ground ❑ Copper and/or Zinc
12. Crop type ber~jk . S. li •�,-,�; M
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ yes E(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 B�No
19. Is there any evidence of wind drift during land application? (i.e. residue on Neighboring vegetation, asphalt, ❑ Yes E3"No
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 E fNo
Air Quality representative immediately.
.Cammestsr(refer to qo} Esplarn aay YES answers an many iecoeans or any�other comments. _ry��
Use drawings of facRit* tti better eacpla�n sitnattans (ase addrdan�al pages as rY)[v�Fteld Coy ❑ Ftnal Notes
1
1&0 �I� ws C4rjcd
DC.CrY�A�t, � �S 51+.. � ii'►i1Flt'�i, k►Of�+� �✓! ,�i�.� rlst �,��Lr� G.lb�,
Sw.4 � �� a�`fi� fie. ��a� �•
tack 1"k '7d..
Reviewer/Inspector Name p �A s
Reviewer/Inspector Signature: Date: D
12/12/03 �� Continued

t
Facility Number: ga _ �O1D Date of Inspection ,? o
Required Records & Documents
ddtubaal Contments'andlor=Diawmgs=�> i —�
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
['No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
631�o
23.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
R*go
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[jd'No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
0 -No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
No
(id discharge, freeboard problems, over application)
❑
C3
27.
Did Reviewer/Inspector fail to discuss reviewlinspection with on-site representative?
❑ Yes
O'fio
28.
Does facility require a follow-up visit by same agency?
❑ Yes
M-f4o
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(f No
NPDES Permitted Facilities
30. Is the facility covered under a NPDBS Permit? (If no, skip questions 31-35) es ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9-96
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes a<0
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 9 -Mo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Ehgo -
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall ❑ Inspection After 1" Rain
120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtubaal Contments'andlor=Diawmgs=�> i —�
I 1
�
.12/12103

Farm Ni
7vlailing
CD�ty: hanpcnn
jntegritor Dogwood Farms, Inc. Phone:_ (910)_592-2104 ext. 316
On Site Representative:_ra.,i 7,4ttLp, nn,gwantj Fa—s Phone:t910) 597_2101,_ _
Physical Address/Location: r` i ima o-1 t,,, �- a i
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENV MONMFXrAL MANAGEAMNT
ANwAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: August i , 3995
Time: [ (5:15
Type of Operation: Swine x Poultry Cattle
Design Capacity: - -12.9 - Number of Animals on Site:
DEM Certification Number: ACE ,, DEM Certification Number: ACNEW
Latitude: !L� 1`1 w Longitude:$r f n w
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) � or No A Freeboard: +� Ft. _ Inches
Was any seepage observed from the lagoon(s)? Yes or NA
any erosion observed? Yes or 1&
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No (Not Evaluated)
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? 11ji or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No (Nor
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -cher Evaluates
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied4Not Evaluated)
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:. -This was a very braif Inspec_tirn_- a marc rhaxnuaIAspection wJII b �
_ conducted iso the future.
Information noted on this inspection was obtained from the interg,rator or DEM _fil pg-
Ifryou have questions regarding this report please contact Paul Rawl§. DEM WatcY Quality
Section at [phone]. —
ai rPvljaw of SL2%tE in2nngemenr sf7s3n_ ar rnrGlxfl: iL -Af3L �►Ol��ii Xfi� — -
Inspector Name ^
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

- . - Division of Water Quality�
J Facility Number CP 0 Division of Soil and Water Conservation O
O Other Agency
Type of Visit NO+Compllance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: I ►i 3 D p Arrival Time: ® Departure Time: County: r n Region: -
Farm Name: , -� til Fos rn _ Owner Email -
Owner Name: — V e-� _ - _ r f1 Phone:
Mailing Address:
Physical Address:
Facility Contact: e_ Title: ney Phone No:
Onsite Representative: Integrator:1-
Certified Operator: �'e- �1� Operator Certification Number, ___ 19
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0
=' = 1[ Longitude: 0 ° = ` = "
Swine
❑ Wean t,
❑ Wean U
eeder
❑ Farrow
❑ Farrow
❑ Farrow
❑ Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
{ I ❑Non -Layer
. rr-
Dry Poultry
Pullets
Poults
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Im acts
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 ves, 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'!
El Yes �No ❑NA (I NE
❑ Yes
❑ No
r�NA
❑ NE
❑ Yes
❑ No
rg-NA
❑ NE
❑ Yes
❑ No
[jtNA
❑ NE
❑ Yes
Eg No
❑ NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
12/28/04 Continued

I
Facility No. 3.1 -4(Q Name
Permit J, -COC ✓
--JN Date
OIC� NPDES (Rainbreaker PLAT Annual Cert)
FB Drops
Lagoon 1 2 3 4 5 6 7
Spillway
_
Design freeboard
Observed freeboard in 3
Sludge Survey Date
Sludge Depth ft & % 3. p9 a,
Liquid Trt. Zone ft r Q,5
Calibration Date
�-besign Width
MUM- 11713,11
Soillest Date
qnP�
pH Fields
Lime NeededDk �no k-,'
Lime Applied
Cu -'-Zn ✓
Needs P
Waste Analysis Date
-60 Day
N Amt (lb11000 Gal)+�'9�1;1
oH�
Crop Yield (e—
Wettable Acres
WUP _ . �--
Weekly Freeboard
Rainfall >1" t:_�
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
jPUGE
or incinerator ��-
J)DI W so wk&rt ly9gj ~�s
Verify PHONE WMh1 RS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm R ods
SQA J per f4IW2
Lagoon
Top Dike 410 41,
Stop Pump CJ3. 1 �� (9/d�
Start Pump 41.3 0, vy )
7 1.1
App. Hardware
she -ext LOTAl A ra
Vic# it 3coo 1 did h1
X,1!7 vk
PrP
will,
- 1+
MMMTac:r rJ
J)DI W so wk&rt ly9gj ~�s
Verify PHONE WMh1 RS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm R ods
SQA J per f4IW2
Lagoon
Top Dike 410 41,
Stop Pump CJ3. 1 �� (9/d�
Start Pump 41.3 0, vy )
7 1.1
App. Hardware
she -ext LOTAl A ra
Vic# it 3coo 1 did h1
X,1!7 vk