770005_INSPECTIONS_20171231

7A If -7
.-
� Divisionr'Tdf Water Resources
Facility Number - I__. 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ® Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I qA 11 1 Arrival Time: Qrq Departure Time: ' � County: R/W ma+r/ Region: figo
Farm Name: !' e �} y�rfjh Owner Email:
Owner Name: /40-1 6 -a,,,l Phone:
Mailing Address:
Physical Address:
Facility Contact: 1�4 =4Title:
Onsite Representative: K
of
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /4p q✓I
Certification Number: r 9'7 7V F
Certification Number:
Longitude:
Design CurrentDesign
Swine Capacity Pop.
Wean to -Finish
Wet Poultry
La er
CaM.
pacity
Current
Pop.
Design C*anent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish 29P,
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr0 HTU-It ,
C•a acl
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker '
Gilts
Non -Layers
I 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 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 I No ❑ NA ❑ NE
❑ Yes ❑ No
[]Yes ❑ No
❑ Yes [:]No
❑ Yes No
❑ Yes No
NA ❑ NE
® NA ❑ NE
®NA [3 NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

acili Number: 27- Date of Inspection: 9 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fp 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: U1144— 2~L►t'0,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): A.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes r No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) LP
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yesiii No [:]NA [:]NE
maintenance or improvement? `�"'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A
12. Crop Type(s):
13. Soil Type(s):
[:]NE
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[—]Yes No
[:]Yes �] No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21 . Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes r No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes � N
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
C:] NA ❑ NE
❑NA ❑NE
❑ NA [:]NE
❑ NA C:] NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
No ❑ NA ❑ NE
No ❑NA ❑NE
Page 2 of 3 214/2011 Continued

Facility Number: H - - Date of Inspection: 9 r!
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KM No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
" No
Lis
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a FOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes NbNo F]NA F]NE
❑ Yes LP
M No ❑ NA ❑ NE
❑ Yes MCNo ❑ NA [3NE
[-]Yes [�9 No
❑ Yes 4r
❑ Yes CpNo
❑ NA ❑ NE
❑NA ❑NE
❑NA []NE
Phone: Q/P'y-?3_,UV0
Date: -9/9//7
21412015

Type of Visit: §1 Compliance Inspection V Operation Neview V Structure Evaluation U "Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Z Arrival Time: l%'i� Departure Time: :00 w County: !�-�/i%l� Region:
Farm Name: A-JI Cn—a17 -r-aY✓t Owner Email:
Owner Name: Ntavl 4" Phone:
Mailing Address:
Physical Address:
Facility Contact: �I %W( /f/� Title: Phone:
1'T
Onsite Representative: Integrator: AI
Certified Operator: +t Certification Number: 79-77"16
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
❑ NE
Design
Current
Design Current
Swine Capaclty Pop.
Wet Poultry
Eapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
er
E-Layer
Dair Cow
Wean to Feeder
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
uItr,
Ca aci
P.o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Lj Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 PNo ❑ NA ❑ NE
[Dyes ❑ No MNA ❑ NE
❑ Yes [:]No NA ❑ NE
[:]Yes ❑No
❑ Yes Wo
❑ Yes [�3No
�iNA
TT❑NA
❑ NE
❑NE
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�No ❑NA ❑NE
[:]No NA ❑ NE
Structure 6
❑ Yes F No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste ,application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes TV No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding F1 Hydraulic Overload [1] Frozen Ground [:]'Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
` Window ❑ Evidence
iof,Wind Drift ❑ A�pp�l�lcatii n Outside of App/r�oved, Area
12. Crop Type(s): t.t�r V� r U/►�'► r I. Cir CMSi�i 1 0. (9 Y LCL4 �,
13. Soil Type(s): AA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
Structure 1
Structure 2 Structure 3
Identifier:
❑ NE
18. is there a lack of properly operating waste application equipment?
Spillway?:
No
❑ NA
Designed Freeboard (in):
Reouired Records & Documents
❑ Weather Code
Observed Freeboard (in):
�
!!
!bt 1
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�No ❑NA ❑NE
[:]No NA ❑ NE
Structure 6
❑ Yes F No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste ,application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes TV No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding F1 Hydraulic Overload [1] Frozen Ground [:]'Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
` Window ❑ Evidence
iof,Wind Drift ❑ A�pp�l�lcatii n Outside of App/r�oved, Area
12. Crop Type(s): t.t�r V� r U/►�'► r I. Cir CMSi�i 1 0. (9 Y LCL4 �,
13. Soil Type(s): AA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reouired Records & Documents
❑ 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
4 9 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
N No
❑ NA ❑ NE
Page 2 of 3
214/2015 Continued

Facility Number: - - Date of Inspection: Z
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 provide documentation of an actively certified operator in chargc7
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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/inspector
Page 3 of 3
❑ Yes E�] No ❑ NA 0 NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes [ No
❑ Yes �No
❑NA ❑NE
[DNA C—] NE
❑ NA ❑ NE
❑ Yes E? No ❑ NA ❑ NE
❑ Yes ®No
❑ Yes T� No
Yes ® No
❑NA C] NE
❑NA 0 N
❑NA ONE
7
cv+ Phone: Lp --V33- 33 CO
Date: Adlk
/4/1015

Type of Visit: 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 41 Arrival Time: p ;pACt Departure Time: County: f IC -9 rAv J P Region: P-0-4
Farm Name: fv e't 6'.hT Owner Email:
Owner Name: rip -0 ( L�'r �:.�v� Phone:
Mailing Address:
Physical Address:
Facility Contact: /\ a( Cil Title: Phone:
Onsite Representative: 1 Integrator: N PGJV
Certified Operator: I,l Certification Number: 9 7 fr
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [P No [] NA ❑ NE
❑ Yes ❑ No [N NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No (P NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 6 NA ❑ NE
2, is there evidence of a past discharge from any part of the operation? ❑ Yes C�g No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Wean to Finish
La er
tt'OC
DaowWean
to Feeder
Non -La er
DaCalf
X Feeder to Finish
352y
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dt. P.aultr.
Ca aci
P,o
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkeyPoults
Other
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [P No [] NA ❑ NE
❑ Yes ❑ No [N NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No (P NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 6 NA ❑ NE
2, is there evidence of a past discharge from any part of the operation? ❑ Yes C�g No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Faciflty Number: - Date of Inspection 2 H
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ] ir;p pr,,. 2V Lo,- sW
1PNo E] NA ❑NE
❑ No r-_9
NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard {in}: f 2�4 30 w
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
`P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window` ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CC r tjwc; ) ��P!( rt ' "rn... L} �� tr ,Sig • �;r �J�'�S c(
13. Soil Type(s): (% ►4
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 T® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes[ ] No E] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [K] No ❑ NA ❑ NE
❑Yes t]No ❑NA ❑NE
Re wired 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 ED Checklists [:]Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - Date of -Inspection: 24I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �B No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE,
❑ Yes 03 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

ZAns ,lz
c-) Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:3 Arrival Time: eparture Time: County: / Region:
Farm Name: Owner Email:
Owner Name: _ &-na/ esmr� Phone: !2Q— 1%1%"' dr
Mailing Address:
Physical Address:
Facility Contact:
Title:
r --
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Integrator: /V[— Airvi-e-1
Certification Number: 97'7
Certification Number:
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Non -L
Pullets
Other
Poults
Design Current
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)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEY Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E3<o ❑ NA ❑ NE
❑ Yes
❑ No
2 -,KA'
❑ NE
[]Yes
❑No
ED A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [V]'NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ltd leo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 2r<o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Fac Ii Number: T7 - Ds ection:
U Yes
[1,eNo
U NA
Waste Collection & Treatment
4. heavy
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
Is storage capacity (structural plus storm storage plus rainfall) less, than adequate?
[]Yes
Bio ❑ 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: 1_-44Q4Mr 2 -
❑ Yes
10
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L;Hl'o
Designed Freeboard (in):
❑ NE
Required Records & Documents
Observed Freeboard (in): — a
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
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.)
❑ Yes
�o
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
©'<oo ❑ 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
B<o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E4o ❑ 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
E�,Ko ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
io ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
U Yes
[1,eNo
U NA
LJ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2 -No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L;Hl'o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
520<s
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Othe
21 . Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [3 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 � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No L! A ❑ NE
Page 2 of 3 1/4/2011 Continued

Facility Number: /1 r7 - I I Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? -
❑ Yes
2<o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[L]►IQo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Yes o
❑ NA
❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes eNo'
❑ NA
List structure(s) and date of first survey indicating non-compliance:
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
2-<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Eq -<A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [2Ko
❑ 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 eNo'
❑ 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 J2,K56
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes E��No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection With an on-site representative?
❑ Yes (2'5o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [:] '
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments }4�t1 "
Use'drawingsof facility to better ex lain situations (use additional ages as necessary).
e our 4z.v+c
il­3//Zu/3
Reviewer/inspector Name
Reviewer/Inspector S
Page 3 of 3
�U-
Phone: ��O 3 �
Date: Al �3
2/4/2011

Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow -up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I Oq.w:] Departure Time: County: yltD,�b Region: 94
Farm Name: I Cwt 14j2 z
Owner Name: r j 6
ea, E - K7r
Mailing Address:
Physical Address:
Facility Contact: N QPJ G-aJ_ Title:
(.1
Onsite Representative:
i1
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No.-
Integrator:
o:Integrator: Pj&- f WVJ; S
Operator Certification Number: r7gr7
Back-up Certification Number:
'Latitude: c =9 0" Longitude: = ° "
IMMI
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle C*apacity Papulation
❑ Wean to Finish
Layer
FEI
❑Dai Cow
❑ Wean to Feeder
Non -La er
❑ Dair Calf
Feeder to Finish
a. Was the conveyance man-made?
❑Dai Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gifts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
NJBeefBrood Cow
❑ No
El Turkeys
❑ NE
Other
❑ Other
❑ Turke Poults
❑ Other I
umber of Structures:
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Discharees & 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
5d NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[M NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
,Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): n
Observed Freeboard (in): f I
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 "P'No ❑ NA ❑ NE
❑ Yes ❑ No -J� NA ❑ NE
Structure 5 Structure 6
❑ Yes 6No ❑ NA ❑ NE
❑ Yes t 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 nNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ❑ Evidence of Wind Drift, /❑ Application Out/side of Area
12. Crop type(s) egret 5J"—, D,C.Q�.4 1 PiYil ?(� �i C9�-al � LOXVSQ�
13. Soil type(s) Ut:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
"j No
[:1NA
[:1NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
51 No
❑ NA
EINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
5
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�, No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
[:1,}
Yes
� No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
' Wa�� on tchw v►�:�
Cou, 1, 4 C-0- f/f:,
do
l.t�l�e Stwv� a�
S�1
� bra�b AMA 47o h rA f,
6 Ccs kej (,,,rts 5
ri`oy­ V4, -)L �
Reviewer/Inspector Name
T Phone: ? t
Reviewer/Inspector Signature:�.
Date: l
Page 2 of 3 12/28/04 Continued

Facility Number: ri— Date of Inspection �[J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 9 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1� 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
tO No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q5 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
1� Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�INo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U3 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
[:1 NA
El 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
79 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
f�)No
❑ NA
❑ NE
Additional Comments and/or Drawings:
inn iLn owe Sub-'sw•-�ce �-a� � ace CFlz s,�,�r s� Pti t� ��s -
A,
Mserec4i ryas a'+� ,ecd- ted- 0+x-1 HF, kf-emPoC ice ac 13 -etqn ho -4
Cp�y, FAo harhoa cof+esof jnse l be -h, nota a,oC ao/r,
I'd
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection '0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: /►+ County: 19.1:�i IMU29 Region: -
Farm Name: Owner Email: '
Owner Name: Phone:
Mailing Address:
i
Physical Address: "
Facility Contact: Title:
14
Onsite Representative:
ti
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: y. pywtll \.�
Operator Certification Number:
Back-up Certification Number:
Latitude: 00 =f =11, Longitude: =O
=L =11
i
+
Design Curreut
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Design Current
Design C+urrent
Design Curreut
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
JEI Layer I 1
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer 1
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to.Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -La ers❑
❑ Pullets
❑ Turkeys
ElNon-Dairy
❑ Beef Stocker
-
Beef Feeder
❑ Beef Brood Cow
❑ Farrow to Finish :
❑ No
❑ Gilts'
❑ Boars '� !Sia,. "
c. What is the estimated volume that reached waters of the State (gallons)?
Qther
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
Disc harees,&*Stream Impacts
1. Is any,`discharge observed from any part of the operation?
❑ Yes
[NNo
[INA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
5 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
5� NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1H No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ES No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structuro Structure 2 / Structure 3 Structure 4
Identifier:IV
�( 0
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in):
e�
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 Po ❑ NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
Structure 5 Structure 6
❑ Yes R No El NA [INE
❑ Yes �j 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 [FNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ID 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 KnNo [INA ❑NE
maintenance or improvement? Lr
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0 N ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑V-vidence of Wind Drift ❑ Application Outside of Area
n
12. Crop type(s)
13. Soil type(s) L%iWA&vrt'
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 1Z No ❑ NA ❑ NE
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5 N [I NA EINE
No ❑ NA ❑ NE
/ No ❑ NA ❑ NE
[!.No ❑ NA ❑ NE
R� R ..z�. i�ib 1$a hA^ �..F
Contm'ents(iefer toyuestion #) Explain any YE$�ansrvers'andl�r any recomrriendatinns or any�other comments -
01
U ici`drawings of: facility to better'expiain situ ations..(use additirin l :pages' r ecessary); y
A6
Reviewer/Inspector Name _ Phone: /0-' 3Or
Reviewer/inspector Signature: Date: 3D
12/28/04 Continued

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

r 0 Division of Water Quality
Facility Number i ► �J - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J Arrival Time: Q Departure Time: County:yV1®n1r� Region:
Farm Name: i� Qcl G. �F—awM Owner Email:
Owner Name: Iyfj� G441- Phone: g10-331-6 AS -Z? (G)
Mailing Address:
Physical Address:
Facility Contact: (V Sed uq-raw Title: Phone: A
Onsite Representative: Integrator: Iv �P{,,( Vyf `j
Certified Operator: t Certification Number:
997 ?ye
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Ury Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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? (1f 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �E No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes T' ` No
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑NA E] NE
❑ NA ❑ NE
Page I of'3 2/4/2011 Continued

FiAlity hbmber: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J;� No ❑ 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: 2-LGkwl
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA [:]NE
(i.e., large trees, severe erosion, seepage, etc.) F
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
❑ 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
[M 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)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
❑ Waste Transfers
❑ Weather
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window L , ❑ Evidence of Wind Drift
Drift 1❑ Application Outside of Approved Area
12. Crop Type(s): l efrl � _iSB+-tf� a,(,5 , Sl�� PeT�Yt.In�A &s d /� SM
13. Soil Type(s):
a
14. Do the receiving crops differ from those designated in the CAWMP?
15. Docs the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes [Z] No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[,g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
2l. 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 D Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Cg No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Fa flit 'Nbmber: Date of Ins ection: f a.
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 CR No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes © No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification`? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit'? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5D No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P, No ❑ NA ❑ NE
❑Yes VI No
NO
❑ Yes FX] No
❑ Yes [5g No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers` a,ndl6r4ny additional recoriiine6dations or any other cnrnments;
Use drawings of facility to better explain situations (use additional pages a.s necessary).
z� �Ci � r7t a!• 11et'!k 4v bg,, Cvf, o
D��snode—mss g Way IWObabty e*etaj
lOsl-r1�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t oo
Date: (d I ;-
2/4/2 bII

w,
Type of Visit 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �^+Arrival Time: % 15kml Departure Time: =County: RN MOAJD Region:
Farm Name:jam! Owner Email:
Owner Name: Al ee C7'ra A Phone:
Mailing Address:
Physical Address:
Facility Contact: Wam Lyury Title:
Onsite Representative: G
Certified Operator:
Back-up Operator:
Phone No:
Integrator: r p1wVIS G�
Operator Certification Number: / 0977,79
Back-up Certification Number:
Location of Farm: Latitude: =0
=I
❑ 41 Longitude: =0=4
°=4 =
Design Current
l0tesign
Current
Swine Cap ty Papulation
Wet Poultry Caty Pop laty
Cattle Opacity Population
❑ Wean to Finish
ElLayer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ No
El Dairy Calf
Feeder to Finishu'O
i,
❑ Dairy Heifer
Farrow to Wean
bry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La S.
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
544o
❑ Turkeys
EINE
Other
❑ Turkey Poults
PNo
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Imaacts
i. Is any discharge observed from any part of the operation?
❑ Yes
%o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
WNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
®NA
❑ NE
2. 1s there evidence of a past discharge from any part of the operation?
❑ Yes
544o
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

z
Date of Inspection
❑ Yes
P No
Facility Number:
❑ NE
Waste Collection & Treatment
❑ Yes
P9 No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 159 No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
E yNA El NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: U
❑ NE
18. Is there a lack of properly operating waste application equipment?
Spillway?:
No
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes N No
❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes FM 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 13 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes V No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes�] No
[:1NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes V No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable Window ❑ Evidence of Wind Drift F-1Application Outside o�f Area
rCrop
I2. Crop type(s
s) �c.2-f'1�,� � ±0 5 !` n�td� SS_J. ✓m,
i
13. Soil type(s) Uatcwr:,,e — j�tJ8�1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
§9 No
❑ NA
❑ NE
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
tion #,): Explain any YES answers and/or any recommendations or any other comments.
CommentsffifficffiI
into better explain situations. (use addltivnal pages as necessary):
Reviewer/Inspector Name a � .. Phone: 9/a 3 3YW
Reviewer/Inspector Signature: Date: gFA a
Page 2 of 3 12128104 Continued

Facility Number: 7'j —5'—] Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists❑ Design g ElMaps ❑ 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
V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�JNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
in Yes
n No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E�lNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
09 No
❑ 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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qNo
❑ 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
P 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
ERNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerdnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�zNo
❑ NA
❑ NE
Page 3 of 3 12/28/04

./V
Division of Water Quality
acility.Number % Q Division of.Soil and Water Conservation
0 Other Agency n .i
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access nn
Date of Visit: Arrival Time: 00•� Qtx, I Departure Time: County: IAI1m7Region: FK�
Farm Name: Owner Email: 1
Owner Name: / 1 e_ �7L Phone: 010 bsa -3018
Mailing Address: 6/0 33 t-6859
Physical Address:
Facility Contact: Alm) (7 ea '► !- Title: Phone No:
Onsite Representative: N Integrator: A46, BOW -01S p�1
Certified Operator: 61 Operator Certification Number: ! O 7
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: =0
=I
0 « Longitude: =0
=d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
aver
�! ❑
Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischartzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design. Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef 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 �rNo ❑ NA EINE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
1� NA
❑ NE
CffNA
❑ NE
❑ Yes
❑ No
[:]Yes
F?No
[INA
❑ NE
❑ Yes
PNo
[:INA
❑ NE
12/28/04 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No T NA [INE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1PNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
EINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
C9NO
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
nNo
❑ 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
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
I0. 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 N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside off Acceptable
// rCrop 1Window ❑�Eviidence of Wind Drifl El Application Outside of Area
12. Crop type(s) q5e-Wj— k'[ J �s4zz urrm JQ � �2 (rT�,� n
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
❑ NA
[:INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,®No
[n No
❑ NA
EINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
C9NO
[:INA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[dNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name r V Phone• i 7S3 Gr/
Reviewer/Inspector Signature: Date:
12/28/04 Continued

J �
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El 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
�]Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
93 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[) No
❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
20 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?
L1Yes
No
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PR No
'❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access —per
Date of Visit: Arrival Time: �g:� /h Departure Time: County: N'mnOf Region: YE""
Farm Name: / 1�(� 4- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: n'
Facility Contact: / V� Title:
l/
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
f/
Phone No:
Integrator: I ily VI.�
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = g = {1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer II
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry 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?
Page 1 of 3
❑ Yes F] No ❑ NA ❑ NE
❑ Yes
❑ No
59 NA
❑ NE
❑ Yes
❑ No
V] NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
12128104 Continued
J

i k
Facility Number: rjj —
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 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the inte it 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 N NA ❑ NE
Structure 5 Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes P 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 Jjj No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes La No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) PeSC�.Q �14a44) , P4-4 M LIA (►1a''l� : Sih, �rr , Qi"8/S �'efJT
13.
Soil type(s) t
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
59 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
C& No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
EINo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: /� 33OiD
Reviewer/Inspector Signatur . Date: 2Q�
Page 2 of"3 12128104 Continued

� k
Facility Number: 7,7 — Date of Inspection 9 7
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 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
rV1No
❑ NA
[:1 NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
g] No
❑ NA
❑ NE
❑ Yes
V] No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page 3 of 3 12128104

r,.
Fr;cility Number p
rDivision of Water Quality Q,,,WVAXY-
0 Division of Soil and Water Conservation
0 Other Agency � I «I we
Type of Visit WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit op�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I / Arrival Time:®® Departure Time: County ` Region:
Farm Name: YJR�C�n� ��lll I r►'h — %�%BU/1'-6i.'t V; o_� Owner Email:
Owner Name: �� QS4Jr �'� 1r(� i t `r" Phone:
Mailing Address: l �`7 7
Physical Address: /�'�� %� / /�
Facility Contact: / V lC�i Q n`f' Title: CJ ujy?Q % Phone No:
Onsite Representative: AJOaJ LAU2:!:J` Integrator: —RLfV l '-5
Certified Operator: / v oj GAIil Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = Longitude: = o = , = {1
NC rl3 cm l 6-f bkA Q4 cry rt cd � Cl�u r c4� 2d • •wo
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
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood 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 *No ❑ NA ❑ NE
❑ Yes ❑ No NNA
❑ NE
❑ Yes ❑ No ,,�TNA
[__1NE
❑ Yes ❑ No__Z�VA
❑ NE
❑ Yes ,E]No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 9— Qb Date of Inspection f [ /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 XNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ANo ❑ NA ❑ NE
❑ Yes A10 ❑ 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 ,07No ❑ 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 MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ No ElNA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El 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) 15Q S CLI em Uj!2 4QLLJj[ i i� z1t iG�,� Q
U V
13. Soil type(s) u (� Aa %i � ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 'MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes *o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes IFf 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 ,&No ❑ NA ❑ NE
❑ Yes tyN0 ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A
he'4 -pla-05 1*0*1143 341b �;L—
Q
/e— cc; 0' C(-f
Reviewer/InspectorName 44( QAJ Phone: <2 /O Y3.7j 07D
Reviewer/Inspector Signature: jDate:
Page 2 of 3 2 4Continued

Facility Number: 91 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesWNo ❑ NA ❑ NE
the appropirate box. ❑ W`Up ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�10
❑ NA
El 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?
❑ YesNo
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
�RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
*E
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
&NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
El NA
El 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
�kNo
❑ 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
,ANo
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
U'7 , I' r+ns {-► ffuA 5-i 6e caa_.1. a ll`Yilhazt�
,I( 0
0 wns f 4,0 SQL. c_mPt� -�o ►� Lk)Q W44 l O
i -z 6k t,� 1: ��� �1 ��A c u. ncr,�.v� /fie
�5 mil.
-
Z rnou-� ec(frn -�o G ss-s -e co`c/
[� 5e uss �%; I� - D ou-ie�^ (neA. <z.<:�er) 4/4Sla4 Sur u N�
PtA
A lob
(qUY .
12128104

V,�14-6o
(xGW
Facility Number l I Date � ��o Time INI5
Out
Owner 14GJ c
Farm Name
� 9-0o"M - V I -
0.I.0 /Vw No. �Swq,�
C O C General -- NPDS
Design Current
Wean to Finish Wean to Feeder_
der in S ? 7,, Farrow to Wean.
Farrow to eeder Farrow to Finish
Gilts $Oars
Other -
Design Current
Soil types r '� lta►�Yi -
Crop Types Pan Window
9
l OAIf nv. O O 50 3 /3 /
kp
Soil Test Plat �� ��
Designed Freeboard
Rain gauge �ain breaker
Observed Freeboard
Daily Rainfall Waste Transfers
Calibration of spray equipment G.P.M.
Sludge Survey Crop Yield 120 Minute inspections-
1 in. Rain inspections +' ! Weather code Weekly Freeboard
Pumping time I Z
Waste Analysis % &Month 9 0T
c,o y�i 3�, S_
Comments
`Zs
t..-�
y
2, 7
3.7
.z V /
I

N,
(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification 4POther ❑ Denied Access
Facility Number Date of Visit: 1 p O Time:
0 Not Operational C Below Threshold
0 Permitted 0 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .._ ....,
Farm Name: .._.__44lat4Lw. L ...... W`.A!�.Lmms s.._. rf%�flL4!4........._._ County: ... ... �!C _...._ .._....
OwnerName: _ _ ._._..._......._...._......._._.... _.._.__....._._..._.._._._............._....... Phone No: _.__._...._._....__............._._.. ....._....__ _ __
MailingAddress:.. _...._._._._._ ..................... .... _._._...._._..._._. .............._._ ._ _ . _._._...__ ..___........ _ ...._._...._._......._ __ ....._... __..
Facility Contact: ...._._. _._............ .. ..._.._. ___._..__._ Title:... _...._.._. _._._.__._...... ___.__. Phone No:
Onsite Representative: .................. ......... _ __. . _ __._......._._........__._ .. Integrator: ___ ........_.__ . __ _........._._..._ . _._..._ .......
Certified Operator:.._......._._.... _.............___... _.. _ ..._._ _ _ _._....__ _...._..._._ Operator Certification Number:..._ _ ..._........__.__.
Location of Farm:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 196 Longitude • 4 ig
Design Current Design Current Resign Current
Swine Capacity Population 'v6ldtry y ci Population Cattle Population
Wean to Feeder MO Layer Dairy
Feeder to Finish 10 Non -Layer Non -Dairy
Farrow to Wean
Farrow to Feeder Other
Farrow to Finish Total Design Capacity
13 Gilts
El Boars Total S` w
Number .of Lagoons L
Disc_ghar es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance 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 ❑ 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 6
Identifier: i _ ..._._ .... ___ ...._ ..._ .._.__....... ____ .. ...._.__._._ ....._ .. _.._._.._._..... _._ .._ . ._.__ ......
Freeboard (inches): I-)_ ?7Z,•
12112103 t_�,r M ^x-`\ Continued

FacilityyNumber: Date of Inspection 9�
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 maintenancetimprovement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

IV
-
Q Diviti n of Sound Water Conservation
Q OtLec Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number r -} Date of Visit: p Time: L D D
Not O erational Below Threshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: c:2A e,a rar%,, Countv: . "k, Q
Owner Name: I Ll'ae1 t,J. l "G w► t" Phone No:
Mailing Address: 0— f3 nX 646 — l ll er4, o IJ C.
Facility Contact: iij ll i c ,,.S Title: Phone No:
Onsite Representative: -fn -. h ►r} : 1l . Integrator: P+.pis 1
Certified Operator: i'� i C1-,o. Sj Operator Certification Number: 1L33-4
Location of Farm:
-0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 D u Longitude • F_�' OK
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 1 10 Laver I 1 10 Dairy
® Feeder to Finish a 1 10 Non -Laver I 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Subsurface Drains Present BLJ Lagoon Area
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation? I--] Yes [UNo
Dischar_e orizinated 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) El 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 E2 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes U No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4v0Q
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection O t7
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
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [� No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes g No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [2 .No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes C9 No
12. Crop type a en-.-, �_ A a -ice :-C S <.L'.'�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 50 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes K] No
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes U No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes M No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ® No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 2INo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [9 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Nj No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ja1 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
re co c-c'":3 ( C, c,U�,rz, 4- F,fvr
1 PLJLJ
1�Y
I.J OLe-oC 14 cc�
t 1. 0J1 o U1_6j
❑ Field Copy ❑ Final Notes
Reviewer/Inspector Name
Reviewer/Inspector Signature: iC k Date: 0 7 p
05103101 Continued

Facility Number:- Date of Inspection d
Odor I i s
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes 2 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No

\1
Facilit.• dumber
Date of Visit: O Time: 3
10 Not -Operational 0 Below Threshold
Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 64i'CL1 Cxe_l W . (t a w►S PC, Y- A Count: 12" e." rn.o-rcj- —1 Ro
Owner Name: cL, S IN i L I' a rr\s Phone No: q I b l a- 3 -4$1
Mailing Address: ck L 41-
Facility Contact: '1 0 l,- i U.<`i"s Title: Phone No:
Onsite Representative: VAZ d"d_Cz Integrator: Pt�ry LZ
Certified Operator: CLC.e,1 I6 wtS Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• �I F " Longitude ��• �• ��
Design Current
Swine Canw-itv Pnnntatinn
❑ Wean to Feeder
® Feeder to Finish
3 p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca acity Po uladon
❑ Laver I ❑ Da'
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1 I- I ILJ Subsurface Drains Present IILJ Lagoon Area IL
Holding Ponds / Solid Traps I J[3No Liquid Waste Management Svstem
Dischar;es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ La¢oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 4_
Freeboard (inches):
J Spray Field Area I
❑ Yes)
No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
RNo
❑ Yes
P No
❑ Yes
(ZNo
Structure 6
05103101 Condnued

Facility Number: — 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
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[� No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type �. m u c, �I �e.s Guy
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[qNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
P No
16. Is there a lack of adequate waste application equipment?
❑ Yes
qNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[@ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
P No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
CD No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
� No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes]
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[5� No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes El No
❑ Yes ® No
❑ Yes W No
❑ Yes W No
❑ Yes No
❑ Yes ❑ No
05103101

Facility Number Date of Visit: Oz Time: : 6O
t Not Operational 0 Below Threshold
Permitted : Certified 0 Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: /%%;dive �11Ar,X' 1—,4X County: /Ci C/�•c�o,✓�
Owner Name: �i rlsiiJL / <)/ /�,a.�-� Phone No: /'fko) a fZ — -7 7,P/
Mailing Address: /0• &2[
Facility Contact: ��=r /Title• Phone No:
Onsite Representative: 772 ✓.t1ce Integrator: N �llLli'/S'
Certified Operator: 1 11-Z-1�//.L�.i Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry [:]Cattle ❑Horse Latitude 0' �u Longitude • • �»
Design Current Design Current Design Current
Swine , Capacity Po ulation Poultry Capacrtv Po ulation Cattle Capacity Po elation
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish 10 Non -Layer. ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure��i>xG5► Structure 3 Structure 4 Structure 5
Identifier: p'
Freeboard (inches): / 2
05103101
Area
❑ Yes A No
❑ Yes KNo
❑ Yes KNo
❑ Yes )i�'INo
❑ Yes KNo
❑ Yes XNo
❑ Yes No
Structure 6
Continued

FacilityNumber: 7 —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 6_z4 sip
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Doealk fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ P, checklists, design, m�.etc.) c�
19. Does record kei ping need improvement? (ie/ irrigation, freeboar waste analysis oil sampe reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNo
❑ Yes ANo
❑ Yes Wo
❑ Yes RNo
❑ Yes �No
❑ Yes FNo
❑ Yes P No
❑ Yes fTNo
❑ Yes XNo
❑ Yes gNo
❑ Yes 9No
,Ryes ❑ No
❑ Yes RNo
❑ Yes KNo
&Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes �gNo
❑ Yes )KNo
❑ Yes ;K No
❑ Yes RNo
❑ Yes RNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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): ❑ Field Conv ❑ final
/Notes
ow A^l'E 143!fe""'e' G'•�_
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: % e2
05103101 Continued

Facility Number: '71 — Jr Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes eNo
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JO No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No
Additional
O5103101

f
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 ❑ Denied Access
Facility Number
Date of Visit: _ -1 Time:
0 Not Operational 0 Below Threshold
#Permitted 0 Certified [3Conditionall . Certified E3Registered Date Last Operated or Above Thres old:
Farm Name: �'r//... .../ c c //. l'1 1�1......1../.` <9'1 Count Gl7.li.......................................................
................... Y ....
Owner Name: f iGlLC� ... CLf�li4�sT5 Phone No: S 2 3 I
p•.0 /I r✓ /-
Facility Contact:........Q.............�...........................................................Title:............................................................... Phon/e/N�o:....................................................
Mailing Address:.....,/ �, /1 ' ......f'.L.(?........................................................................ //' ...' r' /c l .. ....................... �..
.......... .....
...................
Onsite Representative:....... .'r.:....�J./................................................................. Integrator: ...... /V �!.� �... ...L.. �.� .1................... :................
Certified Operator:..Pl.i,C.`
//-!.1-i.c. .... ... ../..(......r..''?Z .................... Operator Certification Number:...........................
..............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 « Longitude • 6 «
Design Current
bwme Capacity Population
PE]
Wean to FeederFeeder to Finish 52e,Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy I —d
Total Design Capacity .0-
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes P(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 Jallo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PF(r-
01/01/01 Continued

J ,
Facility Number: '7— Gil
Date of Inspection 1 _3
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure 1 3ucture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .Pr r
......... ............. ................................................................................
Freeboard (inches) ......... :5..........................� //
6. a ......... ................................... .................................... .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes *0
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application \\
10. Are there any buffers that need maintenance/improvement? ❑ Yes k"O
11. Is there evidence of over application/? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes P(No
12. Crop type
13. Do the receiving crops differ xith those designated in tlteerti
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Animal Waste Management Plan (CAWMP)? ❑ Yes No
azy?
Required Records & Documents ❑ On -site ❑ Off -site
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
El Yes ONO
o
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
WNo
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
RNo
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[$,No
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
23. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
26. Does facility require a follow-up visit by same agency?
❑ Yes
ONO
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
29. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
o
01/01/01
Continued

.1 ,
Facility Number: '
Date of Inspection
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes � No
❑ Yes XNo
❑ Yes Mko
❑ Yes (VNo
❑ Yes ❑ No
10, No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name'
Reviewer/Inspector Signature: Date: 3 •--/ 5-= n
01/01/01

97
Facility Number © Date of Inspection —�—oU
Time of Inspection 6 ?A hr. (hh:mm)
Permitted 13 Certified [3 Conditionally Certified [3 Registered 113 Not Operational Date Last Operated: ..........................
Farm Name: gt.G/ ay../ . kij..L.d!-K1.5.......filrW% ................... County: G !� 0.Q........... .
Owner Name: _
..... %�.c.G. �.tdc........................ . f.,:.C`.rrtn,.5............................... Phone No: ........1. S. z........1�....7.1�r.�.......................................
Facility Contact: e......................................... Title: `�.................... Phone No:
................. //................................................................................................ r
MailingAddress:.......P..Q....L��....6. ..................................................................... ...... ����j.....N. ............................ .........r�3�(f
OnsiteRepresentative: ........... Ok)p.er . ................................................................... Integrator:..............................................................
Certified Operator:,.M.i % '...�.................. {„%,�� 19,A& i;.................... Operator Certification Number:,,,,,,,,,,,,..............................
Location of Farm:
Latitude ' 4 011 Longitude ' ' "
.>wme
Wean to Feeder
!Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number of Lagoons
Holding fonds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer FE]
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
❑ Subsurface Drains PresentlEl Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
)�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes o
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon syste►n? (If yes, notify DWQ) ❑ Yes tNo
o
2. Is there evidence of past discharge from any part of the operation? ❑ Yeso
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yeso
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier:
Freeboard (inches): .... ............
t/7
............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes
seepage, etc.)
3/23/99 Continued on back

Facility Number: 77 -0-5 Date of Inspection Ile -e O-D
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes R110
11. Is there evidence of over applicatio ? /❑ Exces jiive Ponding ❑ PAN ❑ Yes XNo
12. Crop type
13. Do the receiving crops diffeaith those desiViated in L QIrtified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
•violati#ris'oc def ciencies were noted• d0*6#9* this'visit; :Y:oo wiil •Teeeiye iio further' .
correspondence: about this visit` ................................... .
lv!P�`�47���5
❑ Yes PNo
❑ Yes fjkNo
❑ Yes ANo
❑ Yes kNo
❑ Yes )No
❑ Yes (2(No
❑ Yes ANo
❑ Yes To
❑ Yes )` No
❑ Yes ONO
❑ Yes 9-No
❑ Yes ONO
❑ Yes A No
❑ Yes AjTNo
❑ Yes E�rNo
a,a5S SPAY 4 A,5
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ,�—�

Facility Number: 7 7 — r Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes N0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �;_o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

10 Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Fa ility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
rermitted 0 Certified Q Conditionally Certified [3 Registered [3 Not Operat7on`al Date Last Operated:
Farm Name: ..............41d�......Y...r........wi.IJL°jr+ Irk .................... County:.............! 1.!.C�l'!!i:�'.h�d••...ICR�rw ... ...........
Owner Name:............!... / `� r+�!I�` .(................... V" t ` �l(. ��0.7..... 4.7 �....- G ✓�f o
�F/Y4..7�............................. Phone No:.............. .
Facility Contact:............Wlt!I............w!.1[c.r-,...Title:................................................................ Phone No:.................................. .................
'Flailing Address: �r l �....................ClL.�+���,....N.....e............................. aLt33
..................... w.... 3.................................... ...........
Onsite Representative: '�t.�fl .W d !°I?%j�..T.................................... Integrator:....... /�!.:.. : �.lr!!d `.2,f ... �t !C.,.................
Certified Operator:......... ... / 1�1 ............ �ry✓vi.5.................. Operator Certification Number:...,,.....................................
Location of Farm:
................................................................................................ .............................. ........... .................... ....�
.._._.._..
Latitude Longitude
Design Current
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
❑ Farrow to Finish Total Design Capacity 3.5-2 c
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons � ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 StructureA Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ............ .............................6...........................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes �No
❑ Yes 0 No
❑ Yes �No
/✓/ 4-
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes KNO
Structure 6
...............................
❑ Yes No
Continued on aek

Facility Number: ,r,;IV -- /15 Ib/fie Date of Inspection
��..CC 90
6. Are there structures on -site which are not properly (Addressed and/or managed through a waste management or
closure plan? ❑ Yes rVNo
(If any of questions 4-6 was answered yes, and the situation poses an '`
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes VNo
rX
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? _ ❑ Yes [yNo
Waste Application �a k a,, ;i
10. Are there any buffers that need maintenance/improvement? Q�fa; 1"V1 Yes %No
11. Is there evidence of over application? Excessive Ponding ❑ PAN p 4 'r" " ❑Yes No
11
12. Crop type
oc==— -K 1� F _4
13. Do the receiving c ops differ with those designated in tl9 Certified Animal Waste Management Plan (CAWMP)? Yes
14. a) Does the facility lack adequate acreage for land application? 4 a ❑ Yes No
1pkw
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? mpg t ElYes ElNo
15. Does the receiving crop need improvement? a5 fu
3 e ra/ 1/ / LeXYes El No
�w�` atcr�
16. Is there a lack of adequate waste application equipment? G&Op �('_t Q � ❑ ,`Yes �'No
Required Records & Documents Mr. W ;1'ioWv�57 S" b oYe �
17. Fail to have Certificate of Coverage & Genera` 1 Permit readily available? omp
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan r adily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes IM No
rl
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ZON17e
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ryes 6( No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes �No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yiolatioris or• def ciencies •were noted• during •this.
*vis.
it.
* • Yoir wiil•r' eeeiye iio further. :
• correspondence. about this .visit. • • •
Comments (refer to-guesfaou #}. I
Usedrawings of facility to Better ept
Arse : Fwiwvw �qp
�• ll� '�* oM a
i5 AO .
S
pages as
❑ Yes CA No
lir
❑ Yes aO No
❑ Yes KNo
W/lIes T No
nts.
A�� k0k> U41C-t jae.,3 Free -Ant,
l,OZ2 ewe.-L t.-te.
- ovy/l Arc.. 7►to io -�alCt C,� �/�
-1r be VV
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99

r - ti
Facility Number
Date of Inspection — — Time of Inspection [ZL 24 hr. (hh:mm)
13 Registered Certified 0 Applied for Permit [3 Permitted 113 Not Operational Date Last Operated:.......... I .............„
Farm Name:....1. County:...... �.5, /!4n........................................
........ .. ..................
Owner Name:...../.�1.t..:4.......Y...... S.'..�if `. 4W'� 5........................... Phone No: f,PZ ^ 37 ...�
Facility Contact: .Afke J .60a11'4,� . Title: d H e 4�!..............!1-..........Phone No:......
Mailing Address:.....................................,, ....... .........
r1`.7„..............................................L`.�.�...........�...�- Z�r'3S
Onsite Representative:...-.3.. A.'. . i �1 [ Q k't$................................... Integrator: r it I' (/l, S
......................................... ..............................................................
/'� Fk� t cFt!� `GZ S
Certified Operator;..................................................................<........................................ Operator Certification Number;... ...................................
Location of Farm:
Latitude 4 44 Longitude • 6 44
Swine
Design Current
Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
of Lagoons] Holding Ponds
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
0
'o
❑ Yes No
❑ Yes INo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes �INo
❑ Yes V No
❑ Yes )�No
Continued on back

a
IFacility Number: 7 7— 057
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons.11olding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(ft):.......... 22 .................... .............................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(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'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entennin wa ers f he State. notify DWQ)
15. Crop type Fnx4e ( p ,4
i
❑ Yes NIA
ElYes � No
Structure 6
ElYes XNo
❑ Yes KNo
16. Do the receiving crops differ with those des Kggnated in the Animal Waste Management Plan (AWMP)? ❑ Yes KNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes XNo
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste application equipment? ❑ Yes No
20. Does facility require a follow-up visit by same agency? ❑ Yes ko
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes kyNo
22. Does record keeping need improvement? ❑ Yes KNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes JeNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes tNo
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes ❑ No
No.violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit:
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):
Pir- ka-<. ad reSS QIt ems;c r, pro lets no /`.- 1997
aO� SO J
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: tl Date: 27—O

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN T REQUESTED
Michael > iams
Michael Williams Farm
549 W Hwy 73
Ellerbe NC 28338
Farm Number: 77 - 5
Dear Michael B. Williams:
June 23, 1998
1 � •
mom
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND N/QuRAL RESOURCES
You are hereby notified that Michael Williams Farm, in accordance with G.S. 143-215.1OC,
must apply for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter,
your farm has six 60 days to submit the attached application and all supporting documentation. In
accordance with Chapter 676 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any
owner or operator who fails to submit an application by the date specified by the Department
SHALL NOT OPERATE the animal waste system after the specified date. Your application must
be returned within sixty (60) days of receipt of this letter. Failure to submit the application as required
may also subject your facility to a civil penalty and other enforcement actions for each day the facility is
operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package.
The signed original application, one copy of the signed application, two copies of a general location
map, and two copies of the Certified Animal Waste Management Plan must be returned to complete the
application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call at [phone] extension or
Jeffery Brown with the Fayetteville Regional Office at [phone].
Sincerely,
fir' A. P eston oward, Jr., P.E.
cc: Permit File (w/o encl.)
Fayetteville Regional Office (w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

•
a Ly 7 .�
Q DSW-Og3Animal Xeedlot Operation Nor* s F" � ' c� '^m ' *01*.:�"�-'°rx �..rx.' rz
z w DWQ Animal'eec�lot Qperation Site ns echo`
odtine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
I Facility Number '
Farm Status: _ C2,ri I �-i A
Date of Inspection I : f `9. y
TIme of Inspection ®D Use 24 hr. time
ITotal Time (in hours) Spent onReview ®I
or Inspection (includes travel and processing)
1'1i� 42 1 w iAn1S Fq&m 30G Sar�.wCkCo.nty: R1C-k1V�OQ
Farm Name: - �
Owner Name: i 1��a(' �. Q • W i �,� i 0,W1.1 Phone No: �9/o G f 7 37?
Mailing Address: �..,� 6 &X G �1� e r bed, NC_ Z F33 S
Onsite Representative: t1�ae! < i 4► s Integrator. Pa r vi S
Certified Operator. M i c- � Ae Operator Certification Number. 18 3 3 �
Location of Farm:
Latitude Longitude 0• �` 0"
CI Not Operational Date Last Operated:
Type of Operation and Design Capacity
a Number of Lagoons /.Holding Ponds PD Subsurface Drains Present
�� :x Lagoon Area Spray Field
eral '
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWI)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
�kNo
❑ Yes
0 No
❑ Yes
❑ No
❑ Yes
❑ No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
mamtenancelimprovement?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
13 Yes No

6. Is facility not in compliance with any applicable setback criteria? _
7. Did the facility fail to have a certified operator in responsible charge (if inspection after IIIN7)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Pondsl
9. Is structural freeboard less than adequate?
Freeboard (ft): I.a§oon 1 �r La oon 2 Lagoon 3
3 f i;me�ien
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancerrmprovement?
(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 adquate markers to identify start and stop pumping levels?
Waste Anttlicatiou
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Fe SY-- LA
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
Yes No - •
❑ Yes I,�1 No
❑ Yes E'No
❑ Yes ANo
Lagoon 4
❑ Yes ANo
Yes ❑ No
Yes ❑ No
#Yes #No
❑ Yes Cj No
❑ Yes M No
❑ Yes 01 No
❑ Yes IM No
❑ Yes M No
❑ Yes ONo
❑ Yes gj No
❑ Yes No
❑ Yes M No
❑ Yes 9No
Comments (refer. to question#) Explain any YES answers and/or any recoaunendahons or any other comments.
Use drawings of facil>ty o better explain situations Fuse addrtioualpages as aecessar}►) s
#/j /2 L.a9oon bOLA4 rand P4 aroAnd ko"s'es Were Seeded ba+wi blew5eed sF?: bforc ,4-» 4
WQ5 a4a6l;s�eA. Mr. ti;11ja»1S ;S 9oin5 -lo reSeed.
Reviewer/inspector Name
Reviwer/Inspector Signature: tea;
cc: Division of Rater Ouality. Water Ouality Seedow_ Facility Are"emant llait , III .InZ