090052_INSPECTIONS_20171231

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Type of Visit: d<ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: ( toutine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: 0
Arrival Time:
Departure Time: t
County: A (dip Region��
Farm Name• gs
l�
c0 ("
J Owner Email:
Owner Name: I l Phone:
Mailing Address:
Physical Address:
Facility Contact:
p i 7 Title:
Onsite Representative: t {
Certified Operator: Ljj J" t�(.t>�`�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: r r l
Certification Number: 6
Certification Number:
Longitude:
Design Current, f Design Current Design Current
Swine Capacity 1Pop �W tPoultry Gapaci `Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder Non -La er I Dairy Calf
Feeder to Finish }" DairyHeifer
Farrow to Wean Desigtt Current ; Dry Cow
Farrow to Feeder D ult -a acPo airy Farrow to Finish. Layers I I 113eef Stocker
Gilts Non -La ers I I 113eef Feeder
Boars ;, Pullets Beef Brood Cow B
Turkeys f.
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ®,Ko ❑ NA ❑ NE
[:]Yes [—]No ER -NA ❑ NE
[:]Yes [—]No [3'11-A ❑ NE
❑ Yes
[—]No
IA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
QKow
❑ NA
❑ NE
Page I of 3 21412011 Continued

10As
Division of Wafter Resources
Division of Soil and Water Conservation
Other Agency
Facility Number:
090052
Facility Status: Acne
Permit AWS090052
❑ Denied Access
Inspection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit
Routine
County:
Bladen Region:
Fayetteville
Oats of Visit:
10/31/2017 Entry Time; 09:30 am Exit Time: %30 am Incident e
Farm Name:
Ross Lewis Farm
Owner Email:
Owner:
Ross Lewis
Phone:
910-863-3500
Mailing Address:
PO Box 264
Bladenboro NC 283205865
Physical Address:
5044 Berry Lewis Rd
Bladenboro NC 28320
Facility Status:
Compliant ❑
Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm:
Latitude:
34" 31' 08" Longitude:
78' 50' 13"
Hwy 211 South to SR 1176 turn right go to SR 1128, turn left and farm on left 1.5 miles
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Edward R Lewis Operator Certification Number: 18695
Secondary OIC(s):
On -Site Representative{s): Name Title Phone
24 hour contact name Kathy Barker Phone
On -site representative Kathy Barker Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspectorls):
Inspection Summary:
Calibration Sept 15, Sludge Survey 12-11-17 0-4.9, P-4.0 48%
page: 1

Permit: AWS090052 Owner - Facility : Ross Lewis Facility Number. 090052
inspection bate: 10/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 3,200 2,345
Total Design Capacity: 3,200
Total SSLW: 432,000
Waste Structures
Disignated Observed
Type Identifler Closed Date Start Data Freeboard Freeboard
Lagoon 1 19.50 28.00
page: 2

Permit: AWS090052 Owner - Facility : Ross Lewis Facility Number. 090052
Inspection Date: 10/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
yes
Na Na No
1. is any discharge observed from any part of the operation?
[]
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
01313
b. Did discharge reach Water; of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (i.e./ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yea No Na Me
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 100/o/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090052 Owner - Facility : Ross Lewis Facility Number: 090052
Inspection Date: 10/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes
No Na No
Crop Type 1
Gem, Wheat. Soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk
Soil Type 2
coxviile
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
E ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ 0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ E ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

V-
Permit: AWS090052 Owner - Facility : Ross Lewis Facility Number. 090052
Inspection Date: 10/31/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Otherlssues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by Permit?
❑0
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
■ ❑
❑
page: 5

type of visit-. tsrt ompuance inspection V vperanon lcevlew V structure Evaluation U teennlcal Assistance I
Reason for Visit: CD'koutine Q Complaint 0 Follow-up Q Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: F7Y Departure Time: County:
Farm Name: 5f 3 ���"� Owner Email:
Owner Name: 12<,S,5. 4- n,,/ Phone:
Mailing Address:
Physical Address:
Region: �T2o
Facility Contact: f'�ct j� - Title: Phone: r
Onsite Representative: Integrator: Ig `J` _Sa R4,-
Certified Operator: &55�tr�.rt`1 Certification Number: CO (J
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
[,Il<<C1CP.�� Z_o{ 5 0 tZ 93 VUJ 0 zotc` Pc "L
r
Des gn Current
Design Current
Design Current
Swine
T CapiicI
Pop.
Ilty
.Pop
Cattle Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Cnrt e_ nt
Cow
Farrow to Feeder
D P,oW Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
�--
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes �o ❑ NA ❑ NE
[:]Yes
[:]No
O�NA
❑ NE
❑ Yes
[:]No
[;NA
❑ NE
❑ Yes ❑ No [215NA ❑ NE
❑ Yes [2'1lo ❑ NA ❑ NE
❑ Yes a"No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E?[.b;e- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No gD'IGA ❑ 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
�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
[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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�. o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�tNo
❑ NA
❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q-No ❑ NA ❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): . C&O
13. Soil Type(s): ND C b
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes HUG ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [Zj<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes g.No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Epio
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D'lqo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[e]►► o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWIVIP readily available? If yes, check
❑ Yes
E]- o
❑ 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
❑ 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
[ o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
[::]Yes
0 No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

17
Facili Number: - Z Date of Inspection:
�24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg4iv- ❑ 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 E3'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes r❑- -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes []3>o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [g-?Co ❑ NA ❑ NE
[:]Yes [3-No ❑ NA ❑ NE
❑ Yes Q1 N g NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [] Vo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [3'-No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0*-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
G. ?a nay " Y
17-7K_ Z-V
Reviewer/Inspector Name:
Phone: 433` 3_33�
Reviewer/Inspector Signature:
Page 3 of 3
Date: P 4i (Q
21412 J11

61
Type of Visit: CKoroutine
nee Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
F IJV W 11
Arrival Time:
r 0
Departure Time:1 County:
Farm Name:
_ & s
, u� /5
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: k 46 Title:
Onsite Representative: KA
Certified Operator: _ Ev*t , 9,1' 6�
Back-up Operator:
Phone:
Region: C
Phone:
Integrator: k" f
Certification Number: o� 7 r
Certification Number:
Location of Farm: Latitude: Longitude:
-Design Current
Swine Capacity Pop.
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Current
Pop.
o Finish
La er
DairyCow
o Feeder
Non -La er
DairyCalf
to Finish
O
i 11iil " ' DairyHeifer
to Wean
E.Farrowto Feeder
Design Current D Cow
D . $oul Ca aci P,o Non -Dairy
to Finish
La ers.
Beef Stocker
Beef Feeder
Beef Brood Cow
Non -La ers
Otlter
Pullets
Turke s
Turkey Poults
Other
Other
.4,Ts :3-R'ei.�b"_'.�ux..' 'fir.: .:: .: _._ .tr3F•JG:iY�Yui-,
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �5 ❑ NA ❑ NE
❑ Yes
❑ No
[�J`NA
❑ NE
❑ Yes
❑ No
[�lA
❑ NE
❑ Yes
[:]No
❑ Yes
(?I -No
❑ Yes
�No
[2' A
❑ NE
�] NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

r
Faciliq Humber: IDate of Inspection: 7 Fo-
IL
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [adt—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�[�o ❑ NA D NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[&NrT
❑ 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
[9-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CTMo
❑ 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
E3-No
❑ NA
❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®,ale
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes r -W ❑ 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): C t j
13. Soil Type(s): b Cou
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yeses ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑`I�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [T10 Cl NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [3io
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes []5'5o ❑ NA ❑ NE
❑ Yes ❑'1 f<o ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �- o ❑ 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 Inspectio;4o
Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ 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 21412014 Continued

r
FacilityNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [3-Nb [] 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 D.hfiT— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes C].34o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0'< ❑ 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 ❑moo ❑ 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 E�-No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes �o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes R;KNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 42'No [DNA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [ No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: wo
2/4/2014

Facility Number: - Date of Ins ection:
Waste Collection & I reatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E-Koo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes 6p Ko ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LT`S ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[E j.W ❑ 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
[D-Ko ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q44'6 ❑ 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
tla" o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Quo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3,NTt ❑ 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): ct)Jtw. F,.> -f yes _ q
13. Soil Type(s): f y t'l'}A"`
4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑' o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E2j M6 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
[gKo'-
❑ NA
❑ NE
[-]Yes
[a'lglo
❑ NA
❑ NE
❑ Yes
[3' o
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ 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 I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-7go ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [E -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑,ado ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
�,�
❑ Yes l `"o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E;[ PNo
❑ 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 ED'Pfo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes g[ Ko
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0,N0
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes +Io
❑ NA
❑ NE
Comments (refer to question ff): 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).
` -- D c r z o
� x
��
Reviewer/Inspector Name:
Phone:
ReviewerMspector Signature: �} "Ct�'
Date:
Page 3 of 3
21412011

(Type of Visit: Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit:_ (JRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access 1
Date of Visit: — rrival Time: Departure Time: County: v4 Region:
Farm Name
S j
art J r S
Q f i'`"�_
Owner Email:
Owner Name:
05t,
L r;,v i �J
Phone:
Mailing Address:
Physical Address:
Facility Contact: L4 Title: 7;�,-h- Sir. Phone:
Onsite Representative: 1 ;.Z�
Certified Operator: pr/(,(� // 4"'! >
Back-up Operator:
Location of Farm:
Latitude:
Integrator: c�
Certification Numb- . / 9'1i 1
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
eeder to Finish C7
Farrow to Wean
Layer
Design Current
D . Poul Ca aC P,o
Layers
Dairy Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Queer
Other
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 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 gNo ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:cc
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):!
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 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 D NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes F No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PSNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
K7' No
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
Lallo
❑ NA
❑ NE
❑ Yes ZI No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ,No ❑ NA ❑ NE
❑ Yes C5-No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C�kNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2$NO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 97- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
12SNo
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
D.No
❑ NA
❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes K2 -No ❑ NA ❑ NE
❑ Yes [" No
❑ Yes V .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.
Use drawings of facility to better explain situations fuse additional Does as necessarvl.
Nd eSO
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone: T/d
Date:
21412011

Type of Visit: mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: !� 1n Arrival Time:,i J� Departure Time: FqS County: Region: t—T (�
Farm Name: A Z?6 5 �G �iCJ jy /C Owner Email:
Owner Name: - 2 1—Z�-wis Phone:
Mailing Address:
Physical Address:
Facility Contact: i./ Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Fy_�LC1or R L, e--co s Certification Number: /e7L ZIE:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
"y '
Ca aci
P t3'
Wean to Finish
Current
pPo P
Wet P �
oult�
�?' �
I jLayeT
Design
Ca aci
P h`
Current
Po P•
-
NffDesign Current
Cattle Ca aci Po
� P h' P•
Dairy Cow
Wean to FeederI
INon-Layer
I
Design
Ca aci
Current
P,o
Dairy Calf
Dairy Heifer
Feeder to Finish p
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
01 Boars
,-
Other
Epp
�._
e
I]r, Poultr. • ,-..
La ers
Non -La ers
Pullets
Turkeys
Turkey Poults
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
113nef Brood Cow
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
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 [Z No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes gNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of lns ection:
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 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 Q 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 ZI No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes ZLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of/Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): ,5X,,
13. Soil Type(s): NO
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? 0 Yes 2] No ❑ NA ❑ 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?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
D Yes O No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
® No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
10 Yes
❑ No
❑ NA ❑ NE
❑ Waste Application ' ❑ Weekly Freeboard 5gMaste 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
RNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;a No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: aD/
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 provide documentation of an actively certified operator in charge? ❑ Yes Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Callo ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 ReviewerAnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA 0 NE
❑ Yes JKNo ❑ NA ❑ NE
[:]Yes 7fNo ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes No
[-]Yes QK�No
[:]Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
GOV
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: Qll iK�`�.
Date:
21412011
Page 3 of 3

///9/u/v �
4 Division of Water Quality
!Facility Number
--� Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit itompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: ,� Arrival Time: Departure Time: I µ [ I I County:
Farm Name: "�`'�"S `iOwner Email:
Owner Name: wtS Phone: _
Mailing Address:
Region:
Physical Address:
Facility Contact: ` ~�1� Title: �`'' `�G ` Phone No:
Onsite Representative: .r� Integrator: /V-8
Certified Operator: �'' L$.c�lS ` Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = 1
1 Longitude: ❑ ° ='
= "
Design Current Design
Current Design Current
Swine C►apac'tty Population NetPoultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
El Dairy Calf
&Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Layers
❑ Farrow to Finish
El Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cowl
❑ Turkeys
Qther ❑ Turkey Poults
plumber of Structures:
❑ Other 110 Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 B o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NE
❑ Yes
ElEq No
,_�A
A
❑ NE
❑ Yes
[1 No
E A
❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —2 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a, if yes, is waste level into the structural freeboard?
Strugture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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?
El Yes B o ❑NA [I NE
❑ Yes ❑ No Q-KA� ❑ NE
Structure 5 Structure 6
❑ Yes �o ❑ NA ❑ NE
❑ Yes C14o ❑ 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 (9<0 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E3-fgo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��,,
9. Does any part of the waste management system other than the waste structures require El Yes DIN'o' ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ibd goo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes &<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crap type(s) nj ( J , -5,,, 7,,,
13_ Soil type(s) 0o 4�, )
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L7 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
&y -No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ufl o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D-Ko'❑
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):
Yh"
1G ,
Reviewer/Ynspector Name
Reviewer/Inspector SiAll
Page. 2 of 3
Phone:17/10
S.�
Date: /d
12 8104 Continued

Iacility Number: — Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes Blq`o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U,WK ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes ZWo" ❑ 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
El NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElMH Yes
,[J'15fo
o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B"110
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9,Ko
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ek4
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
63Ao
❑ NA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑.Ko
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U,'<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑-Wo
❑ 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
EI-No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El<o❑
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElL_ yes
o-11"'
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

7Bj7 iti1S 1 c' ._- -- 2 e, , t
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1:�—�9` Arrival Time: Departure Time: County: U14G ems%
Farm Name: _ //5 �e W 'S /L�" �"�- Owner Email:
Owner Name: Phone!
Mailing Address:
Region:
Physical Address:
Facility Contact: ��_ r[S�^� Title: Phone
/No: Onsite Representative: D uS <ti Integrator: &a7v'
Certified Operator: 1-t��� Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o =,
=" Longitude: = ° = =
gg
Des rrent De�s�ign Current Design Current
Sviine�Capactj Population Wet Poulttry" Capacity Population Cattle Capacity Popuiation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
❑Non -La er
❑ DaiEZ Calf
Feeder to Finish
❑ Dairy Heifer
Dn Pouf ❑ Dry Cow
❑ La ers El Non -Dairy
❑ Beef Stocker
❑Nan -La ers
El Beef Feeder
❑ Farrow to Wean
!
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Boars
❑ Pullets
ElBeef Brood Co
.Other �� •
El Turkeys
El urkey Points
� �M �a,.
❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
E,TNNA
El NE
El Yes
❑ No
D<
❑ NE
❑ Yes
[I No
�A
El NE
❑ Yes
L_T ivo
❑ NA
❑ NE
❑ Yes
��o❑
NA
❑ NE
12128104 Continued

Facility lumber: 0
Date of Inspection /O- / 9 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 01C ❑ NA ❑ NE
❑ Yes �'N�o ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
i
Observed Freeboard (in): 2-7 ,/
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes L� No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�,�1Vo
6. Are there structures on -site which are not properly addressed and/or managed El Yes LEI ❑ 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 BNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LSNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3N ❑ 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) (f 01- Aj -_LJ Qe-s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,B*I�o
LSNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes
B-Z El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
E No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3< ❑ NA
❑ NE
Comments"(refer to question #) txplain any1k�=ans*&s and/or;any recommendations or any other comments.
Use drawings iif facility to better explain situations*(use addrhoupages as necessary)_:
_1
_
/Vn >f L jL 4J f u// 4 �' � � 1 .-C/t2 I � z
j`,S
.y NS�GC.r" �^� •� fY O �fd f 0 D •-' YG.s 4 � � SH d °'3 Jss�e-r `�C� iJ � G. � G !�
C)6A �� l o c 6 ilk %
�D��Nw'`<.� Y�'7 [R1CG� oT OG 4'Q�+' +.a�ZDO�., �eJd�� �+s A/r ,A5t
ReviewerAnspector Name F_i`c. �•I S. __; . - Phone: 5/0. V 33 .33da
�r
Reviewer/Inspector Signature: Date: %O —Z2—ZCW�
12128104 Continued

Facility Number: Q J — z Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes e<01 ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi Mans
gn ❑ p ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
01No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3 ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CK'o' ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3 o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewertinspector 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
12128104

9XA4S -e j k_ve d/ 7-0/-08
Type of Visit (?rrZu"tilne
nce Inspection O Operation Review O structure Evaluation Q Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: -/7-013 1 Arrival Time: Departure Time: ; .S County: zlae-/ Region:
Farm Name: _ az!; Lc.a x Owner Email:
Owner Name: _ i:055 Phone:
Mailing Address:
Physical Address:
,Q2,D
Facility Contact: ! �b`t5c- Title: T�L* _ 5�u1� / `s Phone No:
OnsiteRepresentative: KQ` �. ��L44/�% Integrator: IWmeV 1, 8r-001AJ
Certified Operator: �d"se'd' jz • C.4.si3� Sr, Operator Certification Number: 1 96 9S
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o ❑ { Longitude: ❑ ° ❑ 1 ❑ l{
Design Current
-
Design
Current _ Design
C►urrent
Swine Capacity Population
V4'etaPoultry
Capacity
Population .cattle = C•apacity
Population
❑ Wean to Finish
❑Laver
❑ Dairy Cow
❑ can to Feeder
on -Layer
El PgnoCalf
- El Dairy Heifer
Feeder to Finish 3 2-007
❑ Farrow to Wean Dry Po`ulty
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑Layers
io ❑ BeefStocker
El Gilts ❑Non -La ers
ElBeef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood c-0
-._ - ❑ Turkeys
Other ❑
Turkey Poults
_ �Ntamber`of Structures:
❑ Other Other
f�
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance ntan-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?
Pa,eIof3
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
❑ No
A
El NE
ElYes
El2 No
A
❑ NE
R A
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA NE
❑ Yes
❑ No
NA
❑ NE
12128104 Continued

w
Facility Number: D9 -ODSL 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z-5
5_ Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L'J 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 El Yes
�,/
Lj✓ No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [--]Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
tj l C-P&; J) So�,�e 0_0
11 Crop types) CO r/
13. Soil type(s) /�a 14
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
eNo ❑ NA
❑ NE
<No❑ NA
❑ NE
L No ❑ NA
❑ NE
ET'N'oo ❑ NA
❑ NE
2 o ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary}:
Reviewer/Inspector NamePhone: �ID. e�33.3300
Reviewerllnspector Signature: Date: 4—/7Z005
Page 2 of 3 12128104 Continued

Facility Number: 09 —0a Date of Inspection —/7-0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L"J 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 ErNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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
❑ Yes
❑,, NNo
❑ NA
❑ NE
ElE Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
[R A
❑ NE
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
EfNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
CfNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
LTI No
❑ NA
❑ NE
Page 3 of 3 12128104

RR $-O& —47
Type of Visit S Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 17 -311 Arrival Time: Departure Time: County: A614don1 Region:
Farm Name: /1 L e y/r`S Owner Email
Owner Name: IROSS L ei&z - Phone:
Mailing Address:
Physical Address:
Facility Contact: X &-Z4 1, 2)q!j i v Title: Phone No:
1.01
Onsite Representative:
Certified Operator: zss Lc_i.J�
Back-up Operator:
Integrator
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = u F--] ' = u Longitude: 0 u = I = u
Design CurrentAWN
Swine Capacity Population
`Design Current Design Current
Wet Poult9, pri ity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
to Feeder
ElNon-La er
❑ Dai Calf
1DWean
der to Finish
7U0w
0 Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
Q4 No
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
El Yes
[� No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
� No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? ([f yes, notify DWQ)
❑Yes
� No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
El Yes
[4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
q No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12/28/04
Continued

Facility Number: 40 — SZ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 54 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Vf No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P 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 2f 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 E;FNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [;9 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [;a No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P§ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Dd No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
lK No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pa No
❑ NA
❑ NE
Comments (refd'i to question #): Explain'any YES,!answers and/or any recommendations or any other comments ; `.
Use. drawings, oftacility to better explain situations. (use additional pages as necessary.)
Reviewer/Inspector Name Phone: 9/d • '133 , 330c)
Reviewer/Inspector Signature: Date: -7 - Z as
Page 2 of 3 12128104 Continued

Facility Number: % — SZ 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 �NNo ❑ NA ❑ NE
the appropirate box.
❑ WL7P ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes jo No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
(j'No
El NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
X No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�] No
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Elyes
ONo
❑ 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
[XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 ! . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
ElNA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
1"
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PdNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

O
iType of Visit (2�t7om pllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforV!sit Routine OComplaint 0 Follow up OReferral OErnergency 00ther ❑Denied Access
Date of Visit: Arrival Time: Q Departure Time: i r3 O County:
Farm Name: R / s S Big i .. S �ar' � _ Owner Email:
Owner Name: C)-3 1[1i Phone: _
Mailing Address:
Physical Address:
Facility Contact: h Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: h7VrAZ4
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = e = 1 = " Longitude: = o = 6 =
di
Design went
FIDesign Current
Design rr Cuent
Swine
Capacity I'opullaa�tion
Wet Poultry
ty Pop*° I' non nnon
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Da Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
ty ty
D Pault .
fi
❑ Dry Cow
❑ Farrow to Feeder
��y
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
-W
❑ Turkeys
Other
❑ Other
a "±
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
[RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
t&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L,No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection llE'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ®..No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [NNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes JR No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9,No ❑ NA ❑ NE
& Do any of the stuctures lack adequate markers as required by the permit? ❑ yes [d 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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
/Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 4f D//t f G[/h r�' r/5B � 5
13. Soil type(s)
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;].No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
ER No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E& 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):
Reviewer/inspector name �-� Phone:
Reviewer/Inspector Signature. Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZ 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 50 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soi] 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
,Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IgNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JSNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
K� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IRNo
❑ 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
g 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
ER 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;K No
❑ NA
❑ NE
Additional Comments and/or Drawings:
1
I'VI
Page 3 of 3 12128104

Type of Visit Q Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p a Arrival Time: Lit' Departure Time: County: Region: P4ZO
Farm Name: Qa SS S rLr- , _ Owner Email:
Owner Name: L Ol fwj&,m� sS Phone: Mailing Address: Pb 1907,� Z. b 4(, gw v+[ ag:m mt✓ 29300
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: Y o5S
Back-up Operator:
Location of Farm:
--swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other -
❑ Other
Title:
��Phone No:
Integrator:
Operator Certification Number: 18 69 S'
Sack -up Certification Number:
Latitude: ❑ o = Longitude: = o ❑ ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et T
Discharges & Stream Impacts
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design ; Current
Cattle Capacity -Population
❑ Dairy Cow
❑ Dairy Calf
❑ DaiEy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:UD
1. Is any discharge observed from any part of the operation?
❑ Yes
[8 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[RNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[8NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
DNA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
ERNo
❑ 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'?
12128104
Continued

Facility Number: 9 — sZ Date of Inspection G 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes.. is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: :fir
Spillway?:
Designed Freeboard (in): (>�
Observed Freeboard (in): Z jr
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 property addressed and/or managed
through a waste management or closure plan?
❑ Yes (9 No ❑ NA ❑ NE
❑ Yes ❑ No R9 NA ❑ NE
Structure 5 Structure 6
,KYes JKNo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E4 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes
N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
No ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No ❑ NA [I NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evide44ce of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C-0 tk
13. Soil type(s) K)OA
i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
EK 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
I T . 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�gneshon�# 0KIN an YES answers and/or any PPRR endations or any other corntneuts.
Use drawings of ty to bee tee eaplam situations. (use additiaiialtpages as necessary):
i� i r+ C[ �00 r►t� 1 L�@ppUO►1� 1 `Yr'! Q•_�
pp /.'C�e.'�-
&A/4AYV10.kS 1+'� Lal.� IL�Mt�y'�. a aµ�►'►'�.�lS ��rr+
1�
�AtUw�-' �wtrr�tdti0.
4 Pam+ -Vi4_ ; CC6 l�
��'! �� H4S t
Se."4 200�_
Reviewer/Inspector Name .._ k I _ , k -, Y_-e ,�.:
Phone: Y• l
Reviewer/Inspector Signature:
Date: lO 31
12128104 Continued

$acility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5� 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.
ElWUP+- El Checklists- ❑Design' ❑Mapsr El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Applicatiorr ❑ Weekly Freeboard ❑ Waste Analysi< ❑ Soil Analysie ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall-❑ Stocking/ ❑ Crop Yield-' ❑ 120 Minute Inspections" 9 Monthly and 1" Rain Inspections ❑ Weather Code--
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
®,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
S &Pwt ❑ Yes
[9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[SNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes © No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
[RNo
❑ NA
❑ NE
Zia S+a # 1 Ko'r Pv+Hwt ot.a -r— CC' �( re.'_ke c- Irc,
Cueti.- A.".) 4K-- vA�+C_ ('j
12129104

Type of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit @ Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Date of Visit: �� J j o y Tune:
Facility Number
O Not Operational 0 Below Threshold
® Permitted ® Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: — ---
Farm Name: _ _ ?. c w ' . � � ► , —T County: �Bl n CI CAA _ FAZo
Owner Name: _ _ o S s _ W„ w ►_ S . _ _. Phone No:.�.+ t G 3 3 Sa a _
Mauling Address: O Q a�f ` ... _ l a�,QC.�, i4c, -ter �.�.. a-92a 0
Facilitv Contact: ^- _- __ . -- - - - Title:.____ _ . _. Phone No:
Onsite Representative:-ti� TG ... �_.... Integrator. _J n u ,- ....
Certified Operator: 17jllar _ _t A, , . S!K _ Operator Certification Number:
Location of Farm:
$`J Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �"
Number ofL' agoons �.
Discharges & Stream Im acts
I. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes R No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Stare other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12 I2103 Continued

• Faciliiy Number;_ 9' — J':) I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes @ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/unprovement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance) mprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozeen Ground ❑ Copper and/or Zinc
12. Crop type �OLV Crc, o /Cr 4 i aN , ..� 1.11► t r_+ , Jo ea'_"
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ER No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 60 No
b) Does the facility need a wettable acre determination? ❑ Yes IN 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 Lssnes
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below (] Yes [P 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 EP No
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Ej 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 4 No
Air Quality representative immediately.
® Field Copy ❑ Final Notes
%-) Co"-0-1
c_ f-
h a.> w cic c P i nj
t'%,n :_7 It c. ra,-U . N o
1,.r1` ct �t-c s a 11nw a �'Fi,•�
oV -t %e- ��clak..tic s;tz}mow..
l�l�a�c rc-pa;r-
a��Q
1
�-hG ��'c��-1LS Gr.o`.
S't-a� wn�aTG
41E�+�•+�T i-'hC s:,ib�Grlti.
�1�4JG
l
�
Q l& vn j�
t
1 4J �+ 1 t3
0 �J Cti �oQ a ti" a �a j G M L S
Kv ..ticj r� Q u ..� $ GQS t
i�Qc7Ci,L�
1v/V�Y
bnAjL
i S
S�A��1.�� 4O
� p
3rcMvt
cjraSS
V
cR'
Reviewer/Inspector Name _ 3
ReAewer/Inspector Signature:
p rac nc Pr lc !c }env L'IJ (u
f G�crcS Zro S(0ty -
Date: 1//4) `f
Continued
12J12t03

FaciW Number: 1 Date of Inspeedon
Required Records & Documents
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?
(iel WUP, checklists, design, maps, etc.) ❑ Yes ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes F�j No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes IM No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/inspector fail to discuss reviewimspection with on -site representative? ❑ Yes [ No
28. Does facility require a follow-up visit by same agency? ❑ Yes (p No
29. Were any additional problems r.-.ted which cause noncompliance of the Certified AWMP? ❑ Yes U No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 0 Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 10 No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [KNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [53 No
35. Does record keeping for NPDES required farms need improvement? ff yes, check the appropriate box below. ff''es ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall EgInspection After I" Rain
W 120 Minute Inspections ❑ Annual Certification Form
12112103

DIVISIOn bf �QII and ,Water COnSEt vation 44
z s
Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint ® Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 09 75 � Date of Visit: 3/22/2004 Time- 11:00
Not Operational OBelowThreshold
® Permitted ® Certified © Conditionally Certified © Registered Date Last Operated or Above "threshold: .........................
Farm Name: Bi.IbCttiy.fujaAl......................... County: Btadea............................................... ERO .............
Owner Name- Bob. ............. ....... ............... B.11b1Cey-----------------
Mailing Address: 657..0jd.T1C=.Rp;j i.......................•---.........
Facility Contact: ...................................
Onsite Representative: Bub.0iffir y.............
Certified Operator:,Fpb..............•••..•.•..
Location of Farm:
Title:
Bisb.rcy................
Phone No: 91Q-fi.4S- 084
Clark1Qiu.NC.......................................................... 2843.3 .............
Phone No:
Integrator: M.urpby_F.awUy..1:_a1G[t1,5...............
.. Operator Certification Number:J.627,3................. _..........
�arin location: 2 miles out of Elizabethtown on Hwy. 87S first state road to the right is Coley Road, turn right on Coley Rd.
io to stop sign. Go straight at stop sign, still on Coley Rd., until get to another stop sign, turn left on Rosendale Rd. Approx. 1
® Swine El Poultry [I Cattle El Horse Latitude 344 • 32 45 y [,ongitude 78 • 35 15
a Wiuc
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
2600
Design Current Design Ctirrent
Poultry' Capacitv Population Cattle Capacity Po ulaton
❑ Laver ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total resign Capacity 2,600
Total SSLW 78,000:J.
Number of Lagoons
Nntdina Pnnrlc / CAIid Tro we
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. vas the conveyance man-made?
h. if discharge is observed, did it reach Water of the State;'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If -yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ❑ No
Waste Collection &'freatmeut
4. is storage capacity (frechoard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure a Structure 4
Identifier:
Freeboard(inches) ............... 24............... ....... .-...................... ........................................ -.................................. --.....................................-....--..-- ....... .... ..........
12112103 t-anrinued

Facility Number: 09-75 Date of Inspection 3/22/2004
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
N'aste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type
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 at/or below ❑ Yes ❑ 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 ❑ No
19_ Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes ❑ 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 ❑ No
Air Quality representative immediately.
Comments (refer to queshoo #). Explain any YES auswers atid/or any recampiendaatins or ady other comments
Use drawings o facility to better explain situations: (use additional pages as necessary): s ®Field Copy ❑Final Notes
Visited farm as follow-up on high freeboard call_ Spoke with Mr. Bilbrey and observed his lagoon to be at 24" and his house was empty.L
Reviewer/inspector Name Larry Baxley :Mark Brantely
Reviewer/l nspector Signature: Date:

I
010 I,--fk
_'r
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Farm Name/Owner Inspection Date Farm No.
ROSS LEWIS FARM 7/12/95 BOC#252
Mailing Address �fP<��� Cb.
P.0 BOX 2b4 �
BLADENBORO, NC 28320 PH.WK 910-862-5252 HOME 863-4592
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Confined Animal Operation Type:
Horses, cattle, swine, poultry, or sheep
SECTION 11
1. Does the number and type of animal meet
the CAFO (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system))
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIMAL
HASTE MANAGEMENT PLAN?
SWINE
Y N Comments
—X— -- —
_X_ -
_X-
—X_ —

5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
HAS NOT SPRAYED - NEW FARM
Adri nistration and Program Management
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
SECTION III
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _3.5FT.
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
— — —x_
Y N Comments
_X_
Y N Comments
_x_
_X._
_X_
_X_
_X_
X
_x_
x

SECTION IV
Comments
THIS IS A NEW FARM. LAGOON LEVELS HAVE NOT REACHED LEVELS REQUIRING LAND
APPLICATION OF WASTES.