090159_INSPECTIONS_20171231

3IMs ZcD Aec-.17 3�)
M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 090159 Facility Status: Active Permit: AWS090159 ❑ Denied Access
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for visit: Routine County: Bladen Region: Fayetteville
Date of visit: 11121/2017 Entry Time: 02:20 pm Exit Time: 2:50 pm Incident a
Farm Name: Big Bay Nursery 9wner Email: [e-mail]
Owner Big Bay Nursery LLC Phone: [phone]
Mailing Address: 818 S Poplar St Elizabethtown NC 28337
Physical Address: 1748 Burney Rd Bladenboro NC 28320
Facility Status: Compliant El Not Compliant Integrator. Prestage Farms Inc
Location of Farm: Latitude: 34' 33' 06" Longitude: 78° 42' 53"
From Clarkton, take Hwy 211 west to Wright Road, turn right, go to the stop sign turn right and farm on left approx. 1 mile -
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Charles M Hardee Operator Certification Number. - 16284
Secondary OIC(s):
On -Site Representativels): Name Titie Phone
24 hour contact name Kathy Barker Phone
On -site representative Kathy Barker Phone
Prtmary Inspector. Bill Dunlap Phone:
Inspector Signature: Dale:
Secondary Inspector(s):
Inspection Summary:
Calibration Sept 15 Sludge Survey 10-24-17 33%
page: i

4
r
Permit: AWS090159 Owner - Facility : Big Bay Nursery LLC Facility Number. 090159
Inspection Date: 11/21/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder 6,080 4,400
Total Design Capacity: 6,080
Total SSLW: 182,400
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
09-159-01
19.00
Lagoon
1
19.00
1 43.00
page: 2

r
•
Permit: AWS090159 Owner - Facility : Big Bay Nursery LLC Facility Number. 090159
Inspection Date: 11/21/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na Ne
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters 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?
❑
M ❑
❑
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
Yea
No Na No
4. Is storage capacity less than adequate?
❑
❑ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./large
❑
❑ ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑ ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (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
❑
❑ ❑
❑
maintenance or improvement?
Waste Application
Yes No Na He
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overioad?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN a 1M6110lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

4
Permit: AWS090159 Owner- Facility : Big Bay Nursery LLC Facility Number: 090159
Inspection Date: 11/21/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Weak Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Hay, Pasture)
Crop Type 2
Coastal Bermuda Grass w/
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1 Foreston
Soil Type 2
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?
❑M
❑
❑
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?
❑
M 0
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No Na Na
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■ ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑
❑
If yes, check the appropriate box below
WtJP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

•
Permit: AWS090159 Owner- Facility: Big Bay Nursery LLC Facility Number. 090159
Inspection Date: 11/21/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yee No Na No
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
■ ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
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,
❑
M ❑
❑
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?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon I Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewfnspection with on -site representative?
❑
M ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

A 00"' n 61 KS aT Iu()Q I
Type of Visit: V�Co—mpliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: JPloutine 0 Complaint 0 Follow-up O Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: { Region: Pw
Farm Name: (' Owner Email:
l�
Owner Name: Li�,L Phone:
Mailing Address:
Physical Address:
Facility Contact: `L 4 'e Title:
Onsite Representative:
Certified Operator: ,,,S_> ca "' e
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design` Current Design CurrentDesign Current
Swine Capacity 'Pop. Wet Poultry. - Capactty�'Pop :. Cattle , C,ap�acity Pop.
Wean to Finish Layer iry Cow
Wean to Feeder (pl L070 Non -Layer I i Calf
Feeder to Finish
airyDHeifer
Farrow to Wean DesignCurrent ' Dry Cow
Farrow to Feeder D , P,oult ,
Ca aci 3n-P,o Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys s
EtherrArheTurkeyPouets
Other
f,
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 EgK`° ❑ NA ❑ NE
❑ Yes
❑ No
r5'NA
❑ NE
❑ Yes
[:]No
[nNA
❑ NE
❑ Yes ❑ No
❑ Yes [ o
❑ Yes [nrNo
g,KA ❑ N E
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Nutnber: jDate of Ins ection: OU
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5-Ner-0 NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�A
❑ 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°^
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Vj'&o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�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
[21Go
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[],No-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [D-5-o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): of-`V(.jA'-_ 56
13. Soil Type(s): T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®llo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ "No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [noNo ❑ NA
❑ Yes �No ❑ NA
❑ Yes ZfNo
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [2rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes O1NV
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ff No
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes `lam<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑i ,15o ❑ 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 [9-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [D'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �o ❑ 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
�o
❑ 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
2No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
❑ Yes
[3�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�No
❑ NA
❑ NE
�-5
J
Reviewer/Inspector Name: L � t 1 �1 Phone:
Reviewer/Inspector Signature: rD Date:
Page 3 of 3 21412015

►K�g Z3 0_TLT-6-1)
U
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0011(outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Pdt" l County: P 1
Farm Name: ��'b Owner Email:
Owner Name: } r Phone:
Mailing Address: r�1� 0"Fe. f�r�
—/7
Physical Address:
Facility Contact: tt[ 6 � 4 Title:
Onsite Representative: it
Certified Operator: S jLic cjt,"tb rrl/r
Back-up Operator:
Location of Farm:
Latitude:
Region: t
Phone: J
Integrator: p r—r
Certification Number: j 4
Certification Number:
Longitude:
Des±gn�Crrent
Design
Current
Design •urrent
Swore
Capaeity� Pop.
Wet Poultry
CapacityCattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
66 CO
11
iNon-Layer
Dairy Calf
Feeder to Finish
= --
Dairy Heifer
Farrow to Wean
ren
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci-
P,,
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
;.
Other
:,:
Turkey Poults
Other
Other
D_ ischarges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
no
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
o
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
WNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility umber: a ----t I Date of Inspection: Cz
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[� ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[::]Yes
[] No
[.
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
/
Q-Na
❑ 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
rest, 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
F71No
❑ 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
To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I© "'o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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): 4 /�1T N�' f
13. Soil Type(s): S ~ GS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L2'<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L3'—No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [:Ko ❑ 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?
Reuuired Records & Documents
[:]Yes LDo ❑ NA ❑ NE
[:]Yes [; o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes ❑.1'do [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�t'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [:]Yes L2'N ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [::]Yes Z No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E"No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection: Tf pC
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EE l ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3-11o'_0 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
[�' o ❑ 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
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
L2-Ko ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
C;10190 [DNA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface the drains exist at the facility? If yes, check the appropriate box below_
❑ Yes
E No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNT?
❑ Yes
ZNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA
'No
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any -YES answers_andlor any additional recommendations or; any. other cornme_rts 5� r
Use drawings of facility to better explain situations (use addihoeal pagesas necessary).
C� b V4' ,_ k`S-t'(
{ S . � - Cf -Is
Ck
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6_3.3 P-L,T-
Phone: �11'- 3
Date: a'-1 0 (q i .S
21412014

(Type of Visit: laroutine
ace Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: A Arrival Time: Departure Time: ounty: Loa Region:
Farm Name: gow
Owner Name: 4i
Mailing Address:
Physical Address:
Facility Contact:
-re," Title:
Onsite Representative: t {
Certified Operator:CT
Owner Email:
Phone:
Phone:
Integrator: fawn"
Jr
Certification Number: I tP
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Cnrrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non-Layer
Dairy Calf
Feeder to Finish
11
IDairy Heifer
Farrow to Wean
-
Design
Curreat
Dry Cow
Farrow to Feeder
D , Poultry
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Uther
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 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 NA ❑ NE
[-]Yes
[—]No
[7�A
❑ NE
❑ Yes
❑ No
E31TA
❑ NE
[:]Yes
❑ No
[3'-NA
❑ NE
[-]Yes
C'Ro
❑ NA
❑ NE
❑ Yes
L _J 5o
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rZ "" ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [g-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[315o
❑ 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
[3-1Go
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�J.?d'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
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3'1'qo ❑ 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?
❑ Yes
[' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETN o
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
[J"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[]�<o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
(No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[D lTo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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
iJ <o
❑ NA
ON I,
Page 2 of 3, 21412014 Continued

PPP7
acili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C5 1q/ [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [&No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes Ia ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [:]Yes [3No ❑ NA ❑ NE
❑ 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?
its (refer to
to
Ji V J1•� 1/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any
❑ Yes
❑ Yes
❑ Yes
P -lC.6
dNo ❑ NA ❑ NE
d N ❑ NA ❑ NE
No ❑ NA ❑ NE
Phone: , —33?y
Date: -z6�4 �'
21412014

r � 4 R1
-11 — -j a i .:z 13 D
Type of Visit: 0 Com iance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
r
Mailing Address:
Physical Address:
Facility Contact: W G(/` Title: %p�
—e.
Onsite Representative: j Integrator:
Certified Operator: nof Y ( Certification Number -
Back -up Operator
Location of Farm:
Phone:
C [ Certification Number:
Latitude:
Longitude:
L 14
26d�3
Design Current
Design Current
Design Cnrrent
SwineVapacity Pop.
>_
WetFoultry Capacity Pap.
Cattle Capacity Pap
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
-
D2'a Heifer
Farrow to Wean
'Design Current
Dry Cow
Farrow to Feeder
D : P,o_ul Ca aci l;o
Non -Da
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ 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 No ❑ NA ❑ NE
❑ Yes
[:]No
dNA
❑ NE
❑ Yes
❑ No
dNA
❑ NE
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
0 No
[tNA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
[O No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [] N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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
reat, 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
[b 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
[g<
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [ENo ❑ 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): g _C og,,,e , .9 G o
13. Soil Type(s): -F0 Irv, G3I _0 V.-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[B No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[FNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑i �No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10
❑ NA
❑ NE
Re wired Records & Documents
19. Did facility fail have Certificate Coverage & Permit
Yes
NA
NE
the to the of readily available?
❑
["No
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Fn--No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�Vo
❑ 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
[jrNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

w �
Facility Number: - 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 ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
Comments (refer to: question#): Explain any YES answers and/or any additional recommendations or any other comm66t t-
Use drawings of facility to better explain situations (use additional pages as necessary).Y
C4, (I ��' t'00
sip y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
la '_��- ra
T-S. 13
Phonegto 13 — s
Date: dui &j &I' 1
Page 3 of 3 21412011

f r_1. n,,.20
Type of Visit: ompliance Inspection Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: ®"Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 3 f — / Arrival Time: r p Departure Time: County: Region:
Farm Name:
AJ a
Owner Email:
Owner Name:�rr„�
Phone:
Mailing Address:
Physical Address:
Facility Contact:
,ZJot.#-A
Title: 72� C , ��� Phone:
IF
Onsite Representative:
Integrator:
01
Certified Operator: ej''t
Certification Number: clg�­L q 31
Back-up Operator:
Certification Number:
Location of Farm:
Latitude: Longitude:
1xt1 Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Ilii
Layer
Design Gnrreat
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Wean to Feeder
Non -La er
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Desig4 Current
D , P.ouItr. Ca aci t o
La ers
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turke s
urkey Poults
Other
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes
fo No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E No
0 NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 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
IS -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
0 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
?MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P3.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 /IWind`ow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Oe/^/yllceL 1 Dttr TS7-�r.,1
13. Soil Type(s): F0 rr-3%j--..-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ® Yes [:]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes S No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[S No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[S No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes [&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 jf27N' No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: -z ry I Date of Inspection: --j J A0
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZLNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ELNo ❑ 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CK No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ®' No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
f 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 ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
RINo
❑ NA
❑ NE
Comments lain any YES answers:
g .Ty „ - � ;, -necessary).
menu=�
Use drawings: of facifer to litytobetter exstionft plain situations use ddrhonal� ay a additional
commendat,aus � Fanykotherr c�otq���
p ( p g
6 ��j^�J "��j 7p— 04--l- �/ �� &-rz--a
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

8
Date of Visit: Arrival Time: Departure Time: ,' County: Region: �T K�
Farm Name: 1 U 5f y Owner Email:
Owner Name: Q e-61G e_ Phone:
Mailing Address:
Physical Address:
Facility Contact: aX t4 ,a rknL Title: i 1«4- _ G, Phone:
— L �
Onsite Representative: Integrator: r
eon
Certified Operator: /"a, II- rl V--- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
�. Design Current.. Design Current
Design Current
Swine AMR Capacity Pop Wet.I tat It ry '�Wapacity Pop.
Cattle C►apacity Pop.
Wean to Finish La er
DairyCow
can to Feeder
= Non -La er
�� ff
�' : �'D`esign Current
DairyCalf
Feeder to Finish
DairyHeifer
D Cow
Farrow to Wean
D1?otilt �Ca aci P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Non -Layer
Pullets
Turks sue."
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
ti ...
Qther
urkey 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 10 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes � No
❑ Yes [Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

lFacility Number: 2T jDate of Inspection: S =
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ELNo ❑ 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): C
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
® 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
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej 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 CropWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �Y/79 mjt-
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 [0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
0 Yes
❑ No
❑ NA
❑ NE
E] Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej No
❑ 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
21412011 Continued

Facifity Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EgNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZI No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes P, No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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 CAWW?
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?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes LA No
[:]Yes ® No
0 Yes fo No
[DNA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question # ) Explain any YES answers and/or any additional recommendations or any ottier`comments. "
Use drawings_of facility to better explain situations"(use additional pages -as uecessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:'p��O�//
21412011

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit @'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: eael Region: friz+,
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: �1 ,/ � I
Facility Contact: M.41 Agri e00— _ Title:
On site Representative: 7VIAV &r-ier
Certified Operator: A44# / relee,_
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: e u Longitude: [� 0 0 d = fl
Design Current Design Current Design Current
Swine Capacity Population �'..et$Popltry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
® Wean to Feeder
b014
IGZ'd3
❑Non -La er
❑Dai Calf
Feeder to Finish
... - ......- _
Dairy Heifer
❑ Farrow to Wean
D� Pdultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ers ❑Beef Feeder
EEl"Boars
❑ Pullets
❑ Turkeys ❑Beef Brood Cow
Otl
❑ Other
I0 Turkey Poults
❑ Other I Number of _ _ _
_ ures:
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 [E o ❑ NA ❑ NE
❑ Yes ❑ No LYNA
❑ NE
❑ Yes ❑ No D<A
❑ NE
❑ Yes [:]No Pl<
❑ NE
❑ Yes 2<o ❑ NA
❑ NE
❑ Yes 2 o ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number0
1-051 Date of Inspection(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,,,,��
E 1vo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[a<o
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: %
Spillway?: Alty
Designed Freeboard (in): /g
Observed Freeboard (in): 113
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2<o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ 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?
El Yes
I_YNo
[INA [INE
S. Do any of the stuctures lack adequate markers as required by the permit?
Yes
El,
I�vo
❑ NA El. NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,,�
LI'No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
LI-Ko ❑ 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) a/m"C��
13.
Soil type(s) r_ r
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[—,c!10 ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
21L ❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ElYes
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? [I Yes
,ff'No ❑
LET No NA
❑ NE
l 8.
Is there a lack of properly operating waste application equipment? El Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use draw irtgs of facility to better eexplain situations�.%(us�e additional pages as necessary):
Z-
Reviewer/Inspector Name �, ; Phone: U 3�
Reviewer/Inspector Signatu Date: /0
Page 2 of 3 / 12f28/04 " Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
,,--,,!!
El NA
[I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
ElI3
,Iwo
No
❑ 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
2<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ek o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ['f No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit`? ❑ Yes (3 No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes `LJ' No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [�io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 1 No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [allo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
K '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
B"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
[90Ko
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��5/
"No
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

3 Tm lo- oq -zoocl
Facility Number
U Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Inspection
O operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
16�ommpliance
&<0'utine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: %Dy` bq Arrival Time: 9.Da/4w- Departure Time: County: J /4d "� Region:
Farm Name: _B;q /yJar_5-e_P v Owner Email:
Owner Name: /Y. �Gye-sl�rrdee��.cc�Dlo/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Nam /lit rdee_ Title: Phone No:
Onsite Representative: &AziL &✓te ►, integrator: Are
Certified Operator: Jov - Crniti 40 1- fA QW Operator Certification Number: A6JA - 99OU6
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
Back-up Certification Number:
Latitude: = o = ' Longitude: 0 0 ❑ ' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
In Oh'a iNon-La et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turke s
ElTurke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Gu
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: R
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

r -
Facility Number:0 C%--/s�j!
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ETNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
M<o
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
I
Observed Freeboard (in): 27
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B 5o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
EK
❑ 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
ElL-
N"o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Moo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2 o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(S) .6eY/i7 r! 4a_
13. Soil type(s) �57-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BN' o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9<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):
Noye G ru F-05S
t_. Yn ) %cvS4.5
C�, NN a pJ O 1 G 4nc'- ,r '*L : psi P, j a lso
Reviewer/Inspector Name Rit=K Reve—i S Phone: 9/a,'A3..3 .33.3,V
Reviewer/Inspector Signature: Date: 7 9—.2OL99
.1 L/L4/U4 %-Unten"Ca

Facility Number: 09 —/$y Date of Inspection
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 appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 Na ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ 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 2rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 2<0 ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes ErN. ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
Ta
❑ NA
El NE
❑ Yes
/
❑ <o
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
L' ] No
❑ NA
❑ NE
l2/2&/04

Type of Visit
ampl'ance Inspection
Operation Review Structure Evaluation
0 Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: [-----,{`=I Departure Time: County:
Farm Name: ! r I Owner Email:
Owner Name; Phone:
Mailing Address:
Physical Address:
Facility Contact: z' Title:
Onsite Representative:
Certified Operator: �r
Back-up Operator:
Phone No:
Integrator:��
Operator Certification Number:
Back-up Certification Number:
Region: f5)� 0
Location of Farm: Latitude: F--I e [=,
= « Longitude: =O = f = 0
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Cap�ascty Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dai Cow
Wean to Feeder
D�
%a
❑Non -La er
❑Dairy Calf
Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
❑ Non -Dairy
❑ La ers
❑Nan -La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
_ ❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
09 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CgNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I 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'?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E8 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CKNo
❑ 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) &Y221 (JC% r'
13. Soil type(s) 7-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UNo
❑ 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
E No
El NA El NE
17. Does the facility lack adequate acreage for land application`?
El Yes
WNo
El NA El NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
- „
Comments (refer to question #) : Explain any YES answers and/or an? recommendations or any other, comments
Use dravtm s of facility-to.,=b' a e .. °
getter'explain situations. (use additional pages as necessary) a�
Reviewer/Inspector Name c5l eve [ ' _ I Phone: Wa-- , -3��C,3
Reviewer/Inspector Signature: Date:

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Jallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 94.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ej No ❑ 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
[Z�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
29No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
19 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 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
21No
❑ 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
I&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
09 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CR No
❑ NA
❑ NE
Page 3 of 3 12128104

A
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit t3'Cornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit & I routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: � � l3 D Departure Time: c3 r 3 b County: �-
Farm Name: //vU r1 Z22= Owner Email:
Owner Name: r Phone:
Mailing Address:
Region:d
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative. Integrator:
M
Certified Operator: C1/ &LI;z ��.a•� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o E__1 I = 11 Longitude: 0 0 =, = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
QED 0 1 10 Non -La et
Dry Poultry
❑ Layers.
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkcx Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
No
El NA
El NE
❑ Yes
,❑l�
ANo
❑ NA
❑ NE
❑ Yes
J�JNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
f Z 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
[9No
❑ 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?
M Yes
❑ No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
)4 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
19 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ERNo ❑ 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. Croptype(s)Pr~
13. Soil type(s) s�-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? U Yes eo ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes [No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
y
Reviewer/inspector Name LA I/, Phone: 9/0_:X33_ 530 0
Reviewer/Inspector Signature: Date: 9 p9id?
12128104 Continued

ei
Facility Number: a -,154A Date of Inspection —
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PSNo ❑ NA ❑ NE
the appropriate box. ❑ VVW ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ 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
[K No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
[3 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit l3rCo—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6-ko-utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival,rime: ime: f Q Q Departure Time: p County:. +`- Region:
Farm Name: Owner Email:
Owner Name: -! r'U{ 1 Phone:
Mailing Address:
Physical Address:
Facility Contact:_„ -_� -__ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: 5z%_
Operator Certification Number:
Back-up Certification Number:
Latitude: = o [ ` ❑ `1 Longitude: = ° ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
S ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
jLV
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
ElTurkeys
El Turkey Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑ DairyCow
❑ DairyCalf
❑ DairyHeifej
❑ Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, Notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes S No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(ZNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: —� Date of Inspection (v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fiSNo ❑ 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 91 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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?
K[Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
SNo
❑ 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
Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes , KNo ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)�!1?�I� /f� U�✓`�
13_ Soil types)"'
y
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 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, El Yes X]No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes IR No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
Gomments (refer to gnestion #): Explain any YES answers and/or any recommendations ar any other comments.
Use drawings of facility tt► better explain situations. (use additional pages as necessary).
7J �Ou1 �,.��-pvn ;�3c�►-t%s O��.vr. �`v `� � 9'z-r�ao� �nd� o�'��.�.
Reviewer/Inspector NamePhone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — 5 Date of Inspection
`i Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �9 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0-Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield R120 Minute Inspections [:]Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes FINo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EgNo
❑ 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
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
19 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
S 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
W 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
2SNo
❑ 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CffNo
❑ NA
❑ NE
Additional Comments and/or Drmyings: A a
Page 3 of 3 I2/28104

Type of Visit ® 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 /p 3I 0 Arrival Time: %- Departure Time: Q : N County: � ���+� Region: F17CV
Farm Name: 19; a jga4 Alt c.&" - __ Owner Email:
Owner Name: /4!t efE 6L4 e_ 511elfe C4te53C1La_4 Phone:
Mailing Address: 54Ui P - oQDC _ f�li za 6P— "La1 L �G- z FS-T ,;
Physical Address:
Facilitv Contact: Title:
Onsite Representative: Kai1�%j _ElUn s..ti > 11 t I,�yf .
Certified Operator: /'-m A
Phone No -
Integrator: Pre- e_
Operator Certification Number: Siri Y 3 i0
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = = 1i Longitude: 0 o ❑ I = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
er ❑ La
(00 (p , ❑ Non -Layer
❑ Wean to Finish
® Wean to Feeder
[:]Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
ElTurkeys
El Turkey Poults
❑ Other
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a_ Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
❑ DairyHeifei
❑ D Cow
❑ Non -Dairy
El Beef Stocket
El Beef Feeder
El Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ZLNo ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
[RNA
❑ NE
(RNA
❑ NE
❑ Yes
❑ No
❑ Yes
14 No
❑ NA
❑ NE
❑Yes
®No
❑NA
[I NE
12128104 Continued

Date of Inspection !0 31 O
Facility Number: — /
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 $2 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: _ _ 1D
Designed Freeboard (in): �..
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q9 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
E0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;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
[] Yes
V No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®,No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
inay (z�s)
(so }
12. Crop type(s) t'vtt � , — s uA A �0. — 64
13. Soil type(s) ST
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EgNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[9 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
is. Pease- add."s ccrKd;f7`v.-_ o,f tra.$s�J w, 0"A Jn.,: Kaff Q_ PrOUP,
`art arrt ��K��`�.r►-f weedls tt,,& skat,Jat iee eLvUressJ wie..,. jpL,,4
swaL� $r-MIw 0yT_4-beee&k .
Reviewerlinspector Name Phone: '114- -1-15- 440 Z-f
Reviewer/Inspector Signature: Date: /0 31 OS
12128104 Candnued

Facility Number: 9 — / Date of Inspection 10 3r O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box.
❑ WUP' ❑Checklists- ❑ Designer El Maps, ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Waste Application JK Weekly Freeboard ❑ Waste Analysis' ❑ Soil Analysis, ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall' ❑ Stocking, ® Crop Yield M 120 Minute Inspections ❑ Monthly and V Rain Inspections' ❑ Weather Code -
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
aNA
❑ 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
LMNo
❑ 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
❑ No
[B 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
9 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
(9 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
M No
❑ NA
❑ NE
dur' Kq rri q ar�ltr+�
yr. lJ�,{� �r�i �i v�4 �p l' P i� S O'►'a �' fG'� Y i P��� �w�
�1_ 6C Sur-t '�af tNet�c�-��ee�oGa.r� reGart�S a� P��<<Y
12128104

(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Facility Number �$ of Visit: ��/ �`P Tune:
C Not Operational O Below Threshold
Permitted ® Certified [r Conditionally Certified 13 Registered Date -Last Operated or Above Threshold:
Farm Name: - ----- RIS Nu r scr County: Q l' ccC1 C�
Owner Name: # �. _ Sit �� L G�� . %+c^ Phone No: , �410� b
Mailing Address: , - 3 D '4 k% c s-r r,�, � a � � .. — .. _ � LS.? � � ci � f a w � G � . -?9 3.3 7.
FacMty Contact:
Title:
Phone No:
Onsite Representative: ka�► q u� g v Integrator. Pc bTu1] C
Certified Operator. Operator Certification Number.
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �` �" Longitude •
Die es & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes [J No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 5 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 & 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 b
Identifier• �
Freeboard (inches):
0?9"
.12112103 Continued

iracility�Wumber: — /�$' j Date of Inspection
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/unprovement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ 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 maintenancelrmprovement? ❑ Yes No
11, Is there evidence of over application? If yes, check the appropriate box below. ❑ yes No
❑ Excessive Po/ndd�ing ❑ PAN [I Hydraulic Overloads (❑ Frozen Ground ❑ Copper/and/or Zinc
^. Crop type ClP rrrt u_ �� r'& i w) 1 to 1: e- rJ e 'r nC
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 Q9 No
b) Does the facility need a wettable acre determination? ❑ Yes Q No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes 0 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 E�LNo
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.
se drawrngs :ai >WM7sio' lyetttt� a�lam satuat>forts- [use gages naryl 10 Field Copy ❑ Final Now
JAJaa+C- 5aTM-p ft �►a 6 a,�,a s= 't o-C-C.
{` % r O wci 4, 4 5 ria l AJ�C .
R G- e- b'- a L S 5�. + h`, t a r t Q i� ,� �t{ ►1� 1 S 6 1^^ L C� 6 I-i- Gr k r- 4a
C O 0,,,.10 n A,, O V r
5Or•+C CtirGhCr.S F111C�'6v
I
4+06Oe
n
�IriC
a�'4
[
e'C?ril+to�Tc4-
4 j V' a 5S tv'l a r.,� 4* V
I�f
cr ►v k
1 r..y p
11
r e y 4 b
�r w..�oPc,
i t ,
Reviewer/Inspector Name vr. � m _ r. _ � T � �� " � `.. - ss � � p � f
Reviewer/haspector Signature: Date:
12112103 - Condntred

Facility Number: — /s Date of Inspection /
Reauired Records & Docnments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
U No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
[E No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C9 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
m No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
1%] No
27. Did Reviewer/hupector fail to discuss review/inspection with on -site representative?
❑ Yes
Ul No
28. Does facility require a follow-up visit by same agency?
❑ Yes
(P No
29. Were any additional problems noted which cause noncoru^liance of the Certified AWMP?
❑ Yes
EP No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slap questions 31-35) ❑ Yes ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32_ Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
l2/l2/03

.....:�•".:.�•�T.;,:`::
aoaaa¢2 an: , 'sf •a€4�Re�"`�'°�bj "s
�Q Division of Soil and Water Conservation Q Other Agency
.55
®Division of Water Quality °
-. ae n ..•���e.��"'- p^'^�':,��%?..�a;"';�^'....�...'^"""".�'..-u�.:x{^«w•�.i��="•�.u.,�".-�,..,.�..: ...-_».,,�� sf sr��:� '�''.r� sue
It Routine O Comnlaint O Follow-up of DWO inspection O Follow-up of DSIVC review O Other
Date of inspection)
Facility Number O
Time of Inspec:tion 24 hr. (hh:mm)
13 Registered ■ Certified 0 Applied for Permit © Permitted 10 Not O eratianal Date Last Operated:
FarmName: ..................P Pg., ......... .... County:............... lt........................................
r�
Owner Name: ......... �J4!......................./j� die Phone No-. ...... l��l..... A.....:...�` .�r ............ r..... 1�.:.............1f .
Facility Contact: ................................................. ......... Title: ...... Phone No:
MaiUmg Address: .....Z, .o......... Ac....��3�.3 ....:................ ..........................
Onsite Repre-tentative:........... La..l,��........... a� ... ''J Integrator:........1. e&,1 1....QiS/�r.......
Certified Operator; ......�..... / :........,��.G�!J.............. Operator Certification Number,.....f.29 .......
Location of Farm:
C
ME
Latitude 0' ' 66 Longitude =• ' 0"
+ -: Design! urretit
'` Design anent urrent
�
R,
k. 3 Y .. �•�'t°z4i' a •$y,
,WVb44� ' ''R•
S�vt�ne:`Capacity Population. Poultry ` Capacrty `Populatwn, Cattle Capacaty,
:opulatfgnR
' ❑ Layer ❑ Dairy w
M�
❑ Non -Layer; ❑Non -Dairy
a-;'
❑ other
�" Total Design Capacity
µ x
T metal
, To SLW f A,
S
h
�a.�r�., w.� ,mow: ,�
-N�er of Lagoons / Holding Ponds
•.
❑Subsurface Drains Present © Lagoon Area ❑Spray Field Area
1
�k
y max. ,':. xFF
u µ
❑ No Liquid Waste Management System y
: f q
y
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
❑Yes N3 No
2. Is any discharge observed from any part of the operation?
❑Yes P!�No
Discharge originated at: [I Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made?
El Yes KNo
b, if discharge is observed, did it reach Surface Water? (If yes, notify DVVQ)
❑ Y`es�
c. If discharge is observed, what is the estimated flaw in ual/min?
ftg[No
A. Does discharge bypass a lagoon system`? (If yes, notify DVVQ)
❑yes �No
3. is there evidence of past discharge from any part of the operation?
❑Yes ANo
4, Were there any adverse impacts to the waters of the State other than from a discharge?
El Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
El Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes )VNo
7. Did the facility fail to have a certified operator in responsible charge?
❑Yes KNo
7125197
Continued an back

Facility Number: G f-
8. Are there lagoons or storage ponds on site which need to be properly closed? ElYes bKNo
Structures (Gagoons,tioldins Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
14 No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identities:
2 �
Freeboard (ft):.................................................................................................................................................................................
. ............................. ..
10. is seepage observed from any of the structures?
❑ Yes
No
11. is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
XNo
12. Do any of the structures need maintenance/improvement?
❑ Yes
WO
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13, Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
XNo
Waste_ Application ,
14. Is there physical evidence of over application?
❑ Yes
[YNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
b.T?2h...u0,��b*?�
15. Crop type ...... ..............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes XNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
1(No
18. Does the receiving crop need improvement?
❑ Yes
WO
19. Is there a lack of available waste application equipment?
❑ Yes
ONo
20. Does facility require a follow-up visit by same agency?
❑ Yes
NrNo
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
22. Does record keeping need improvement?
~Yes
// ``
[I No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
'�`
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
No'violations-or defidencies.were ni 6ted-during this:visic- You:will i&e' ive-iro-f6rtlier
:�:-ctirrespondeitcealioutthis'visit.-"�:�:�::�:•�� � -;�::�:�:�'� �:•-:•;�:� ;�'�:-:-:•:�:�:�'�:�:�:-:�
�,��.-C2 7.�J�s�.a �� , or G'a��.....✓ / 1. •
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature. ` ��,�.,/� 4
Pate: Knzm� r_

0 Routine O Complaint O Follow-up of DWQ inspection O Follow-uR of DSWC review O Other
Facility Number
Date of Inspection -T— f 7
O /,�
Time of Inspection j fl'C-O 124 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status:
❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated:.,,....... _ . -.. r...
Farm Name:. ;F-deral c County:
Land OwFmer Name:! . /!�'"� Phone No:
Facility Conctact:... G"ai�Ris Si�.�✓f�i. ..... �_ Title: _.. _.. _.... _ ... Phone No: .... ..._... _ ....._.__. ._.
Mailin; Address:
Onsite Representative:_....?Ries..y�,,�K.........----
�.... Integrator:_
�
Certified Operator: ___j!tL1W�! .�' �'^J .............W� _. .. Operator Cer$ilication Number:
Latitude 0 6 OK Longitude • 4 �u
Type of Operation and Design Capacity
' . Curet r i,
�DeStgn: ��rn � F � u:
x Cattle3s
�Ca acl Pa elation' y ... , tw Ca HC1 PO nl8thOU
e•e,
Wean to Feeder Gv (� : �I❑ La er � ❑ .
❑Feeder to Finish �❑ Nan La er ❑ Non
1 arTOW t0 Wean ¢ y b s zW . sxpk 4
x
Farrow to Feeder V fiH ID 661g' HV Capacity
Farrow to Finish
�❑ Other
�Number of L'aV as 1 Holding Ponds I ❑Subsurface Drains Present ;
w
«.
... �� r5 Lagoon Area. ❑ Spray Field Area;
iT` °.
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes A No
2. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes %No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) [:]Yes b[No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge b)Tass a lagoon system? (if yes, notify DWQ) ❑ Yes KNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes WNO
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ElYes PNO
4/30/9 7 maintenance/improvement?
Continued on back

Facility Number:..4 ?_.—....1.s?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
kNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
OkNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
gNo
Structures (La;oons and/or I1oldir4 Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
gNo
Freeboard (ft): Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
10. Is seepage observed from any of the structures?
❑ Yes
INo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
'�(No
12. Do any of the structures need maintenance/improvement?
❑ Yes
Xio
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13, Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ANo
Waste Amilication
14. Is there physical evidence of over application?
❑ Yes
XNo
(If in excess of WMLP, or runoff entering waters of the State, notify DWQ)
.... ..... _ ......... ..
15. Crop type ................-............. .......... ....... ..... _....... ......... ._._.... -...............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
I No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑Yes
20. Does facility require a follow-up visit by same agency?
❑ Yes
1*0
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
brNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/�No
24. Does record keeping need improvement?
gYes
❑ No
Comments (refer to'queshon # Ezplatn any YES answers and/or.any rec rnmendattons or"any other continents `
Use diawtrigs of facility to better eXpisiri6situatiaris.` (use additibiial pages as necessary) t
4-, w �
2Y I e -
Reviewer/Inspector Name "' a,
ReviewerlInspector Signature: � rGd �� �T Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7-14 1995
Time: LD /S
Farm Name/Owner: k-1401 In e KE r-rH-4&.�
Mailing Address: 'cP. o. gam. 13 t 3_ __jB a -vsoptz _ �? C as 3 >
County: l �n -
Integrator:Phone:--
On Site Representative:q-�%,, M ` K � � �J - Phone: - $ — 41 s
Physical Address/L.ocation: :!5Saz,' of �a--. -_v r a 4r- a
Type of Operation:/ Swine Poultry Cattle
& Design Capacity: 000 Number of Animals on Site: 45_:::9L0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) �r No Actual Freeboard:ELZ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oef—wDNas any erosion observed? Yes olzfla�
Is adequate land available for spray? 67i:br No Is the cover crop adequate? Yes ordSrD:) * fJ;r K�gr is
Crop(s) being utilized: ecA/E
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? <f s_ r No
100 Feet from Wells? for No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or T�o
Is animal waste discharged into water of_lbe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or
Additional Comments: rJDT `�tv 2�-
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

.
ti
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Date I Farm No.
Mailing Address
Fs Al f3Df20 /v C ZS 3 ZO r✓ Go[.eNr
• - /Sd� ' �..u1., fjby�¢� =� �C . /il"Oc. �asrr r �J _
All questions answered negatively will be discussed in suffic nt detail
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
Confined Animal Operation Tye:
Horses, cattl , s ne, poultry, or sheep
Y. ji Comments
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 6 S1RA ?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. • Does this facility have a CERTIFIED MIKAL
WASTE RANADE ANT plAHI _
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?

r
administralion -and Program Hanjoement Y 1H
5. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
SECTION
field
III
Site Management
X h Comments
I.
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?C
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 q�
CERTIFICATION PLAN? Y
5.
Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
�L
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? Now much? (Approximately
S.
Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION iY
Comments X)e.0�T_OCXJ�_ 5;1AAE / F

PLO
NORTH CAROLnM D13PARTlhTi'1' OF ENVIRONMENT, ESAI.TN' 6 NATMIAL RESOURCLS
DIVISION OF ENV3"RONMENTAL
Fayetteville Regional Cffice
Animal Operation Compliance Inspection Fora
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All questions answered negatively will be discussed in sufficient detail in
the,Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
51?CTION I
Animal ration : NL r5o'y (wecu-er -to Keene♦)
Horses, cattle, swine, poultry, or sheep
SECTION II
Y ( N i CDMMMTs
1. Does the number and type of animal meet or exceed
the (.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 KEG STRATIO .
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIYM li►NniAL
WASTE MANAGEMENT PLU?
5. floes this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

a
5E(�'IC1F ,n�
.Fieldite Mara Ment
1. Is animal waste stockpiled or lagoon
censtructicn xithia 100 It. of a USG5
Map Blue Lille Stream?
2. is animal waste land applied or spray
irrigated wit -bin 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
CXRTIMATIM Aar
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 GStTTFIOM?
7. Does animal Waste lagoon have sufficient
freeboard? How much? (Approximately )
8. is the general condition of this CRFB facilitg,-
including management and operation,
satisfactory?
MW=ON IV
Commentg
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pleas. =stu= the c Isted forma to the Divisj
the add~ ess on the reYsras side CC Lhia form.
HjU9 gf firm (Woorn print) r
Address : _. Q D_ 5 2( t S 13
7rIPW ?h
tar= locati8m., Iarir::.�} ..•,,I Longietiaa-��
please attach a copy of a county road map 111;
'3ye� mL uperation (swine, layez, dairy, etc.)
Doaiefn eapacitx (+1kjaLL-Cz of animals)
Average sire of operation`(12 nonrh population
Average acreage needed for land application of
'=acLy;,ica1 S�scialfsL csxti�3a;tion
As a technical specialist designated by the
Conservation Corsm.ission pursuant to 15A NCAC Sr ,
expanded animal waste managesent system as l^st
has ar. animal waste managemenc plan that me
cueration and Maintenance standards and sFect
Znvizonmental MA-riagement and the USDA -Soil Conser-I
Carolina Soil and Water Conservation Co=iss$cn pa
15A NCAC GF .0001-.0005. The following elements a
criteria-tsaare_been verified by me or other designs
are included in the plan as applicable: mini== se
equivalent for lagoons or waste storage ponds: wa:
quantity and amount of land for waste ut`_I-zatior{
or pz:wpe_ waste appliYAt.on equirn
applications; application rates; loading rates; ax
of pollutar_cs from stor=wa er runoff is less sg
storm. {,.4.s p AfpSprAj TWTIS t i
Naze of Technical Specialist (Please Print)
Affil_ation- K-S IU
Address (Agency) :
Nc
Sigaa,ture _,
^13ii`1' !-T.:ss; trig s3a�il==�Iasa:asiaa;yiil�ti i!/!�i!
I (we) understand the operatior.iuid :nai ntanance j
approved animas. waste z-a-mage_ment plain for th.e fa=
these p-ocedures. x (we) know that ar-y additior
design capacity of the waste treatment and storage
facilities will require a new certification to he
Zzivironmertal b1fanagemenc he=oze the new an-ma?s
=dersta.nd that there must be no discharge of ar_i:
surface ::ate_s of t e state either th_cugh a ma
r-_,roff L_om a stogy event less severe than. the
approved plan_ will be f=led at the fa--= -_nd at the
Stater Corser-ration District.
:7a=e of Lame o-w; er (Please Prir-t') :
Signat:.[_ e
*ta:. 01 2ianasar, if different from m-mer {please
Signature!
NlztA: A change in laa:d`
(if the apt,roviE—d plant
�..r��r.n�nr+taT M�.i�e-ninon.
oaz:ershi.p regu;;zes motifs_:
is chlanged) to be vulz
XMV_L 4tmea=al Hanagesest at
(required) . Also,
cArinn identified.
-
.): rQ a
e (ac_es)I
th Carolina Soil and Ovate_
)5, 1 certify that the new or
ed for the fa= named above
the design,- constzuczion,
rations of the Division of
:ion Service and/or the Nqrth
mant to 15A NCAC 2H.0217 and
their coriesponding rainimusm
_d tee.hpicai specialists and
rations (buf:ess)I- linerq' or
Lk storage capacity; 'adequate
Use
Q f t}T : riartlr) y-%canoo
zt: schedule far timing WE
the control of the discharge
ire than the Z5.-yegr, 24-hour
Phone No.
-ed=ez establis .ed in the
ed above and will imp l e.msnt
expa-7sion to the existing
stets or const-n:ction of rLew
bmitted to the Division pf
:e stocked. I (we) also
waste fz n t :is System to
ade corveya.Ice or thxough
Year, 24-nouw sto na. The
fice of the local Soil a:d
Date: -
Date:
an or a new Certificat_an
ted to the Division of

AL!. 4

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